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http://en.wikipedia.org/wiki/Substance_abu se Substance abuse

From Wikipedia, the free encyclopedia

Substance abuse
Classification and external resources

Comparison of the perceived harm for various psychoactive drugs from a poll among medical psychiatrists specialized in addiction treatment[1] ICD-10 ICD-9 DiseasesDB MeSH F10..1-F19..1 305 3961 D019966

Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts. The terms have a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines (particularly temazepam, nimetazepam, and flunitrazepam), cocaine, methaqualone, and opioids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.[2] Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions. Substance abuse is a form of substance-related disorder.

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Contents
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1 Classification o 1.1 Public health definitions o 1.2 Medical definitions o 1.3 Drug misuse o 1.4 As a value judgment 2 Signs and symptoms 3 Epidemiology 4 History o 4.1 APA, AMA, and NCDA o 4.2 DSM 5 Society and culture o 5.1 Legal approaches o 5.2 Cost 6 Treatment 7 See also 8 Notes 9 Further reading 10 External links

[edit] Classification
[edit] Public health definitions

Source: A Public Health Approach to Drug Control in Canada, Health Officers Council of British Columbia, 2005 Public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasizing the role of society, culture and availability. Rather than accepting the loaded terms alcohol or drug "abuse," many public health professionals have adopted phrases such as "substance and alcohol type problems" or "harmful/problematic use" of drugs. The Health Officers Council of British Columbia in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada has adopted a public health model of

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psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence (see diagram to the right).

[edit] Medical definitions

In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognize 'drug abuse' as a current medical diagnosis. Instead, DSM has adopted substance abuse[3] as a blanket term to include drug abuse and other things. ICD refrains from using either "substance abuse" or "drug abuse", instead using the term "harmful use" to cover physical or psychological harm to the user from use. Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) ). Its section Substance dependence begins with: "Substance dependence When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. These, along with Substance Abuse are considered Substance Use Disorders...." [3] However, other definitions differ; they may entail psychological or physical dependence,[3] and may focus on treatment and prevention in terms of the social consequences of substance uses.

[edit] Drug misuse

Drug misuse is a term used commonly for prescription medications with clinical efficacy but abuse potential and known adverse effects linked to improper use, such as psychiatric medications with sedative, anxiolytic, analgesic, or stimulant properties. Prescription misuse has been variably and inconsistently defined based on drug prescription status, the uses that occur without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of abuse or dependence symptoms.[4][5] Tolerance relates to the pharmacological property of substances in which chronic use leads to a change in the central nervous system, meaning that more of the substance is needed in order to produce desired effects. Stopping or reducing the use of this substance would cause withdrawal symptoms to occur.[6]

[edit] As a value judgment

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Legal drugs are not necessarily safer. A study in 2010 asked drug-harm experts to rank various illegal and legal drugs. Alcohol was found to be the most dangerous by far. Philip Jenkins points out that there are two issues with the term "drug abuse". First, what constitutes a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries. Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in many Western countries, while drinking several bottles is seen as an abuse. Strict temperance advocates, which may or may not be religiously motivated, would see drinking even one glass as an abuse, and some groups even condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use of marijuana or amphetamines constitutes drug abuse implies that we have already decided that substance is harmful even in minute quantities.[7]

[edit] Signs and symptoms

Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.[8] There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.[9] In the USA approximately 30 percent of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.[10] Drug abuse, including alcohol and prescription drugs can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation

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of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia[citation needed]. Severe anxiety and depression are commonly induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate alcohol sustained use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.[11] Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others.[12] Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however; drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally marketed under the name "ReVia," and now marketed in intramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of alcohol dependence. This drug has reached very few patients. This may be due to a number of factors, including resistance by Addiction Medicine specialists and lack of resources.[13] The ability to recognize the signs of drug use or the symptoms of drug use in family members by parents and spouses has been affected significantly by the emergence of home drug test technology which helps identify recent use of common street and prescription drugs with near lab quality accuracy.

[edit] Epidemiology

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2002. no data less than 40 40-80 80-120 120-160 160-200 200-240 240-280 280-320 320-360 360-400 400-440 more than 440

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The initiation of drug and alcohol use is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from Monitoring the Future (2008), a nationwide study on rates of substance use, show that 47% of 12th graders report having used an illicit drug at some point in their lives [14]. In 2009 in the United States about 21% of high school students have taken prescription drugs without a prescription.[15] And earlier in 2002, the World health Organization estimated that around 140 million people were alcohol dependent and another 400 million suffered alcohol-related problems.[16] Thankfully, the large majority of adolescents will phase out of drug use before it becomes problematic. Thus, although rates of overall use are high, the percentage of adolescents who meet criteria for substance abuse is significantly lower (close to 5%) [17]. According to BBC, "Worldwide, the UN estimates there are more than 50 million regular users of morphine diacetate (heroin), cocaine and synthetic drugs."[18]

Total recorded alcohol per capita consumption (15+), in liters of pure alcohol[19]

[edit] History
[edit] APA, AMA, and NCDA
In 1932, the American Psychiatric Association created a definition that used legality, social acceptability, and cultural familiarity as qualifying factors: as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien."
[20]

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision': 'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior. In 1973 the National Commission on Marijuana and Drug Abuse stated: ...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has

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become no more than an arbitrary codeword for that drug use which is presently considered wrong.[21]

[edit] DSM
In the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (published in 1952) grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness. The third edition, published in 1980, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance. In 1987 the DSM-IIIR category "psychoactive substance abuse," which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous." It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis. By 1988, the DSM-IV defines substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal." Substance abuse can be harmful to your health and may even be deadly in certain scenarios By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association, the DSM-IV-TR, defines substance dependence as "when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed." followed by criteria for the diagnose[3] DSM-IV-TR defines substance abuse as:[22]

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household) 2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

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3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

The fifth edition of the DSM (DSM-5), planned for release in 2013, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-5 discussion.

[edit] Society and culture

[edit] Legal approaches
Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug prohibition Most governments have designed legislation to criminalize certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history. Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health.[23][24] In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens.[citation needed] Despite drug legislation (or perhaps because of it), large, organized criminal drug cartels operate worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

[edit] Cost

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The UK Home Office estimated that the social and economic cost of drug abuse[25] to the UK economy in terms of crime, absenteeism and sickness is in excess of 20 billion a year.[26] However, it does not estimate what portion of those crimes are unintended consequences of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition.[27] The Home Office has a recent history of taking a hard line on controlled drugs, including those with no known fatalities and even medical benefits,[28] in direct opposition to the scientific community.[29]

[edit] Treatment
Treatment for substance abuse is critical for many around the world. Often a formal intervention is necessary to convince the substance abuser to submit to any form of treatment. Behavioral interventions and medications exist that have helped many people reduce, or discontinue, their substance abuse. From the applied behavior analysis literature, behavioral psychology, and from randomized clinical trials, several evidenced based interventions have emerged:

Behavioral Marital Therapy Motivational Interviewing Community Reinforcement Approach Exposure therapy Contingency Management[30][31] Pharmacological therapy - A number of medications have been approved for the treatment of substance abuse.[citation needed] These include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and naltrexone in either short acting, or the newer long acting form (under the brand name Vivitrol). Several other medications, often ones originally used in other contexts, have also been shown to be effective including bupropion (Zyban or Wellbutrin), Modafinil (Provigil) and more.

In children and adolescents, cognitive behavioral therapy (CBT) [32] and family therapy [33] currently have the most research evidence for the treatment of substance abuse problems. These treatments can be administered in a variety of different formats, each of which has varying levels of research support [34] It has been suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious.[35]

[edit] See also

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http://www.medicinenet.com/drug_abuse/article.htm

What is drug abuse?

Drug abuse, also called substance abuse or chemical abuse, is a disorder that is characterized by a destructive pattern of using a substance that leads to significant problems or distress. It affects more than 7% of people at some point in their lives. Teens are increasingly engaging in prescription drug abuse, particularly narcotics (which are prescribed to relieve severe pain), and stimulant medications, which treat conditions like attention deficit disorder.

What is drug addiction?

Drug addiction, also called substance dependence or chemical dependency, is a disease that is characterized by a destructive pattern of drug abuse that leads to significant problems involving tolerance to or withdrawal from the substance, as well as other problems that use of the substance can cause for the sufferer, either socially or in terms of their work or school performance. More than 2.6% of people suffer from drug addiction at some time in their life. The term dual diagnosis refers to the presence of both a drug-abuse or dependence issue in addition to a serious mental-health problem in an individual. Substance abuse or dependence unfortunately occurs quite commonly in people who also have severe mental illness. This is important given that people with a serious mental illness are far more at risk of engaging in violence, being incarcerated, or contracting infection with the human immunodeficiency virus (HIV). Individuals with dual diagnosis are also at higher risk of being noncompliant with treatment.

What types of drugs are commonly abused?

Virtually any substance whose ingestion can result in a euphoric ("high") feeling can be abused. While many are aware of the abuse of legal substances like alcohol or illegal drugs like marijuana (in most states) and cocaine, less well known is the fact that inhalants like household cleaners are some of the most commonly abused substances. The following are many of the drugs and types of drugs that are commonly abused and/or result in dependence:

Alcohol: Although legal, alcohol is a toxic substance, particularly to a developing fetus when a mother consumes this drug during pregnancy.

Amphetamines: This group of drugs comes in many forms, from prescription medications like methylphenidate (Ritalin, Concerta) and dextroamphetamine and amphetamine (Adderall) to illegally manufactured drugs like methamphetamine ("meth"). Overdose of any of these substances can result in seizure and death.

Anabolic steroids: A group of substances abused by bodybuilders and other athletes, this group of drugs can lead to terrible psychological effects like aggression and

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paranoia, as well as devastating long-term physical effects like infertility and organ failure.

Caffeine: While it is consumed by many, coffee, tea and soda drinkers, when consumed in excess this substance can produce palpitations, insomnia, tremors and significant anxiety.

Cannabis: More commonly called marijuana, the scientific name for cannabis is tetrahydrocannabinol (THC). In addition to the negative effects the drug itself can produce (for example, infertility, paranoia, lack of motivation), the fact that it is commonly mixed ("cut") with other substances so drug dealers can make more money selling the diluted substance or expose the user to more addictive drugs exposes the marijuana user to the dangers associated with those added substances. Examples of ingredients that marijuana is commonly cut with include baby powder, oregano, embalming fluid, PCP, opiates, and cocaine.

Cocaine: A drug that tends to stimulate the nervous system, cocaine can be snorted in powder form, smoked when in the form of rocks (crack cocaine), or injected when made into a liquid.

Ecstasy: Also called MDMA to denote its chemical composition (methylenedioxymethamphetamine), this drug tends to create a sense of euphoria and an expansive love or desire to nurture others. In overdose, it can increase body temperature to the point of being fatal.

Hallucinogens: Examples include LSD and mescaline, as well as so-called naturally occurring hallucinogens like certain mushrooms, these drugs can be dangerous in their ability to alter the perceptions of the user. For example, a person who is intoxicated with a hallucinogen may perceive danger where there is none and to think that situations that are truly dangerous are not. Those misperceptions can result in dangerous behaviors (like jumping out of a window because the individual thinks they are riding on an elephant that can fly).

Inhalants: One of the most commonly abused group of substances due to its accessibility, inhalants are usually contained in household cleaners, like ammonia, bleach, and other substances that emit fumes. Brain damage, even to the point of death, can result from using an inhalant just once or over the course of time, depending on the individual.

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Nicotine: The addictive substance found in cigarettes, nicotine is actually one of the most habit-forming substances that exists. In fact, nicotine addiction is often compared to the intense addictiveness associated with opiates like heroin.

Opiates: This group is also called narcotics and includes drugs like heroine, codeine, Vicodin, Percocet, and Percodan. This group of substances sharply decrease the functioning of the nervous system. The lethality of opiates is often the result of the abuser having to use increasingly higher amounts to achieve the same level of intoxication, ultimately to the point that the dose needed to get high is the same as the dose that is lethal for that individual by halting the person's breathing (respiratory arrest).

Phencyclidine: Commonly referred to as PCP, this drug can cause the user to feel extremely paranoid, become quite aggressive and to have an unusual amount of physical strength. This can make the individual quite dangerous to others.

Sedative, hypnotic, or antianxiety drugs: As these substances quell or depress the nervous system, they can cause death by respiratory arrest of the person who either uses these drugs in overdose or who mixes one or more of these drugs with another nervous system depressant drug (like alcohol or an opiate).

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http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

Drug Abuse and Addiction

Signs, Symptoms, and Help for Drug Problems and Substance Abuse
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Some people are able to use recreational or prescription drugs without ever experiencing negative consequences or addiction. For many others, substance use can cause problems at work, home, school, and in relationships, leaving you feeling isolated, helpless, or ashamed. If youre worried about your own or a friend or family members drug use, its important to know that help is available. Learning about the nature of drug abuse and addictionhow it develops, what it looks like, and why it can have such a powerful holdwill give you a better understanding of the problem and how to best deal with it.

In This Article:

Understanding drug use, abuse, addiction How drug abuse, addiction develops Signs and symptoms Warning signs in others Getting help for drug abuse and addiction When a loved one has a drug problem When a teen has a drug problem Related links Authors Text Size

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Understanding drug use, drug abuse, and addiction

People experiment with drugs for many different reasons. Many first try drugs out of curiosity, to have a good time, because friends are doing it, or in an effort to improve athletic

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performance or ease another problem, such as stress, anxiety, or depression. Use doesnt automatically lead to abuse, and there is no specific level at which drug use moves from casual to problematic. It varies by individual. Drug abuse and addiction is less about the amount of substance consumed or the frequency, and more to do with the consequences of drug use. No matter how often or how little youre consuming, if your drug use is causing problems in your lifeat work, school, home, or in your relationshipsyou likely have a drug abuse or addiction problem.

Why do some drug users become addicted, while others dont?

As with many other conditions and diseases, vulnerability to addiction differs from person to person. Your genes, mental health, family and social environment all play a role in addiction. Risk factors that increase your vulnerability include:

Family history of addiction Abuse, neglect, or other traumatic experiences in childhood Mental disorders such as depression and anxiety Early use of drugs Method of administrationsmoking or injecting a drug may increase its addictive potential

Drug addiction and the brain

Addiction is a complex disorder characterized by compulsive drug use. While each drug produces different physical effects, all abused substances share one thing in common: repeated use can alter the way the brain looks and functions.

Taking a recreational drug causes a surge in levels of dopamine in your brain, which trigger feelings of pleasure. Your brain remembers these feelings and wants them repeated. If you become addicted, the substance takes on the same significance as other survival behaviors, such as eating and drinking. Changes in your brain interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs. Whether youre addicted to inhalants, heroin, Xanax, speed, or Vicodin, the uncontrollable craving to use grows more important than anything else, including family, friends, career, and even your own health and happiness. The urge to use is so strong that your mind finds many ways to deny or rationalize the addiction. You may drastically underestimate the quantity of drugs youre taking, how much it impacts your life, and the level of control you have over your drug use.

How drug abuse and addiction can develop

People who experiment with drugs continue to use them because the substance either makes them feel good, or stops them from feeling bad. In many cases, however, there is a fine line between regular use and drug abuse and addiction. Very few addicts are able to recognize when they have crossed that line. While frequency or the amount of drugs consumed dont in themselves constitute drug abuse or addiction, they can often be indicators of drug-related problems.

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Problems can sometimes sneak up on you, as your drug use gradually increases over time. Smoking a joint with friends at the weekend, or taking ecstasy at a rave, or cocaine at an occasional party, for example, can change to using drugs a couple of days a week, then every day. Gradually, getting and using the drug becomes more and more important to you. If the drug fulfills a valuable need, you may find yourself increasingly relying on it. For example, you may take drugs to calm you if you feel anxious or stressed, energize you if you feel depressed, or make you more confident in social situations if you normally feel shy. Or you may have started using prescription drugs to cope with panic attacks or relieve chronic pain, for example. Until you find alternative, healthier methods for overcoming these problems, your drug use will likely continue. Similarly, if you use drugs to fill a void in your life, youre more at risk of crossing the line from casual use to drug abuse and addiction. To maintain healthy balance in your life, you need to have other positive experiences, to feel good in your life aside from any drug use. As drug abuse takes hold, you may miss or frequently be late for work or school, your job performance may progressively deteriorate, and you start to neglect social or family obligations. Your ability to stop using is eventually compromised. What began as a voluntary choice has turned into a physical and psychological need.

The good news is that with the right treatment and support, you can counteract the disruptive effects of drug use and regain control of your life. The first obstacle is to recognize and admit you have a problem, or listen to loved ones who are often better able to see the negative effects drug use is having on your life.

5 Myths about Drug Abuse and Addiction

MYTH 1: Overcoming addiction is a simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will. MYTH 2: Addiction is a disease; theres nothing you can do about it. Most experts agree that addiction is a brain disease, but that doesnt mean youre a helpless victim. The brain changes associated with addiction can be treated and reversed through therapy, medication, exercise, and other treatments. MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction processand the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Dont wait to intervene until the addict has lost it all. MYTH 4: You cant force someone into treatment; they have to want help. Treatment doesnt have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change. MYTH 5: Treatment didnt work before, so theres no point trying again. Recovery from drug addiction is a long process that often involves setbacks. Relapse doesnt mean that

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treatment has failed or that youre a lost cause. Rather, its a signal to get back on track, either by going back to treatment or adjusting the treatment approach.

Signs and symptoms of drug abuse and drug addiction

Although different drugs have different physical effects, the symptoms of addiction are similar. See if you recognize yourself in the following signs and symptoms of substance abuse and addiction. If so, consider talking to someone about your drug use.

Common signs and symptoms of drug abuse

Youre neglecting your responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use. Youre using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex. Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit. Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends.

Common signs and symptoms of drug addiction

Youve built up a drug tolerance. You need to use more of the drug to experience the same effects you used to attain with smaller amounts. You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety. Youve lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldnt. You may want to stop using, but you feel powerless. Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drugs effects. Youve abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use. You continue to use drugs, despite knowing its hurting you. Its causing major problems in your lifeblackouts, infections, mood swings, depression, paranoiabut you use anyway.

Warning signs that a friend or family member is abusing drugs

Drug abusers often try to conceal their symptoms and downplay their problem. If youre worried that a friend or family member might be abusing drugs, look for the following warning signs:

Physical warning signs of drug abuse

Bloodshot eyes, pupils larger or smaller than usual.

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Changes in appetite or sleep patterns. Sudden weight loss or weight gain. Deterioration of physical appearance, personal grooming habits. Unusual smells on breath, body, or clothing. Tremors, slurred speech, or impaired coordination.

Behavioral signs of drug abuse

Drop in attendance and performance at work or school. Unexplained need for money or financial problems. May borrow or steal to get it. Engaging in secretive or suspicious behaviors. Sudden change in friends, favorite hangouts, and hobbies. Frequently getting into trouble (fights, accidents, illegal activities).

Psychological warning signs of drug abuse

Unexplained change in personality or attitude. Sudden mood swings, irritability, or angry outbursts. Periods of unusual hyperactivity, agitation, or giddiness. Lack of motivation; appears lethargic or spaced out. Appears fearful, anxious, or paranoid, with no reason.

Warning Signs of Commonly Abused Drugs

Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss. Depressants (including Xanax, Valium, GHB): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness. Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose. Inhalants (glues, aerosols, vapors): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash. Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion. Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.

For more symptoms and effects of commonly abused drugs, see the Helpguide PDF Factsheet.

Warning signs of teen drug abuse

While experimenting with drugs doesnt automatically lead to drug abuse, early use is a risk factor for developing more serious drug abuse and addiction. Risk of drug abuse also increases greatly during times of transition, such as changing schools, moving, or divorce.

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The challenge for parents is to distinguish between the normal, often volatile, ups and downs of the teen years and the red flags of substance abuse. These include:

Having bloodshot eyes or dilated pupils; using eye drops to try to mask these signs. Skipping class; declining grades; suddenly getting into trouble at school. Missing money, valuables, or prescriptions. Acting uncharacteristically isolated, withdrawn, angry, or depressed. Dropping one group of friends for another; being secretive about the new peer group. Loss of interest in old hobbies; lying about new interests and activities. Demanding more privacy; locking doors; avoiding eye contact; sneaking around.

Getting help for drug abuse and drug addiction

Finding help and support for drug addiction

Visit Narcotics Anonymous to find a meeting in your area. Call 1-800-662-HELP in the U.S. to reach a free referral helpline from the Substance Abuse and Mental Health Services Administration.

Recognizing that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength. Facing your addiction without minimizing the problem or making excuses can feel frightening and overwhelming, but recovery is within reach. If youre ready to make a change and willing to seek help, you can overcome your addiction and build a satisfying, drug-free life for yourself.

Support is essential to addiction recovery

Dont try to go it alone; its all too easy to get discouraged and rationalize just one more hit or pill. Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from drug addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance. Support can come from:

family members close friends therapists or counselors other recovering addicts healthcare providers people from your faith community

Recovering from drug addiction

Addiction is a complex problem that affects every aspect of your life. Overcoming it requires making major changes to the way you live, deal with problems, and relate to others. To learn

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about the tools that can help you on your journey to sobriety, read: Overcoming Drug Addiction: Drug Abuse Treatment, Recovery, and Help

When a loved one has a drug problem

If you suspect that a friend or family member has a drug problem, here are a few things you can do:

Speak up. Talk to the person about your concerns, and offer your help and support, without being judgmental. The earlier addiction is treated, the better. Dont wait for your loved one to hit bottom! Be prepared for excuses and denial by listing specific examples of your loved ones behavior that has you worried. Take care of yourself. Dont get so caught up in someone elses drug problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support. And stay safe. Dont put yourself in dangerous situations. Avoid self-blame. You can support a person with a substance abuse problem and encourage treatment, but you cant force an addict to change. You cant control your loved ones decisions. Let the person accept responsibility for his or her actions, an essential step along the way to recovery for drug addiction.

But Dont

Attempt to punish, threaten, bribe, or preach. Try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to use drugs. Cover up or make excuses for the drug abuser, or shield them from the negative consequences of their behavior. Take over their responsibilities, leaving them with no sense of importance or dignity. Hide or throw out drugs. Argue with the person when they are high. Take drugs with the drug abuser. Feel guilty or responsible for another's behavior.

Adapted from: National Clearinghouse for Alcohol & Drug Information

When your teen has a drug problem

Discovering your child uses drugs can generate fear, confusion, and anger in parents. Its important to remain calm when confronting your teen, and only do so when everyone is sober. Explain your concerns and make it clear that your concern comes from a place of love. Its important that your teen feels you are supportive. Five steps parents can take:

Lay down rules and consequences. Your teen should understand that using drugs comes with specific consequences. But dont make hollow threats or set rules that you cannot enforce. Make sure your spouse agrees with the rules and is prepared to enforce them.

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Monitor your teens activity. Know where your teen goes and who he or she hangs out with. Its also important to routinely check potential hiding places for drugsin backpacks, between books on a shelf, in DVD cases or make-up cases, for example. Explain to your teen that this lack of privacy is a consequence of him or her having been caught using drugs. Encourage other interests and social activities. Expose your teen to healthy hobbies and activities, such as team sports and afterschool clubs. Talk to your child about underlying issues. Drug use can be the result of other problems. Is your child having trouble fitting in? Has there been a recent major change, like a move or divorce, which is causing stress? Get Help. Teenagers often rebel against their parents but if they hear the same information from a different authority figure, they may be more inclined to listen. Try a sports coach, family doctor, therapist, or drug counselor.

Related articles

Overcoming Drug Addiction Drug Abuse Treatment, Recovery, and Help

Alcohol Treatment, Rehab, and Detox How to Stop Drinking and Start Recovery

More Helpguide Articles:

Alcoholism and Alcohol Abuse: Signs, Symptoms, and Help for Drinking Problems Understanding Depression: Signs, Symptoms, Causes, and Help Anxiety Attacks and Disorders: Signs, Symptoms, and Treatment Feeling Suicidal? Coping with Suicidal Thoughts and Help to Get You Through How Addiction Hijacks the Brain

Bonus Article for HELPGUIDE.ORG from Harvard Health Publications Resources and references for drug abuse and drug addiction
Understanding drug abuse, drug addiction, and its effects

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Addiction and the Brain's Pleasure Pathway: Beyond Willpower Describes how the brain becomes addicted and why relapse is so common. (HBO.com) Drugs, Brains, and Behavior: The Science of Addiction (PDF) Booklet on drug addiction, including its effects on the brain and new approaches to preventing and treating the disease. (National Institute on Drug Abuse)

Signs and symptoms of drug abuse and drug addiction

Signs and Symptoms of Drug Use Covers physical and behavior signs and symptoms of drug use, as well as drug specific symptoms. (American Council for Drug Education) Substance Abuse Symptoms Checklist Checklist of substance abuse and drug addiction warning signs. Also see signs and symptoms in teens. (National Council on Alcoholism and Drug Dependence of the San Fernando Valley) Signs and Symptoms of Drug Use Includes general signs and symptoms of drug use, as well as links to more detailed, drug-specific information. (Narconon International)

Common drugs of abuse and addiction

StreetTalk Pamphlets Series of straight-talking pamphlets on the ever-changing world of street drugs. Includes articles on crystal meth, ecstasy, heroin, and club drugs, among others. (Do It Now Foundation) Prescription Drugs: Abuse and Addiction (PDF) Government guide to the growing problem of nonmedical use or abuse of prescription drugs. (National Institute on Drug Abuse)

Drug abuse and drug addiction in teens and young adults

TeensHealth: Drugs and Alcohol Straightforward talk on drug and alcohol abuse in a question and answer format, written for teens. (Nemours Foundation) How to Tell if Your Teen is Using Guide for parents on spotting the warning signs and symptoms of drug use in teens and how to take action to intervene. (The Partnership for a Drug-Free America)

Help for drug abuse and drug addiction

Narcotics Anonymous worldwide services for overcoming drug addiction, including searchable database of local meetings and support groups. (Narcotics Anonymous) Authors: Lawrence Robinson, Melinda Smith, M.A., and Joanna Saisan, MSW. Last updated: August 2011

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http://www.childrensuniversity.manchester.ac.uk/interactives/science/bodyandmedicine/goodandb addrugs.asp

Good of drug Medicine are always good drug that help you get better or stay healthy. Example are calpol, antibiotics and insulin. Remember though:if you took medicine too much, it can make u very poorly. Always read the labels. Take the correct dose for the correct number of time per day.

Bad of drug Bad drug are substances that can make you very poorly. Examples of bad drugs are nicotine, alcohol, solvent and illegal drugs like cannabis, amphetamines, cocaine and heroin. Some of these drugs are addictive, and the user may turn to crime to get money to buy the drug. If the user is caught with illegal drugs they are likely to go to jail. Always say NO. Remember ;never take bad drug as they can very dangerous and may even cause death,

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http://www.biopsychiatry.com/
THE GOOD DRUG GUIDE THE RESPONSIBLE PARENT'S GUIDE TO HEALTHY MOOD-BOOSTERS FOR ALL THE FAMILY

INTRODUCTION Could we live happily ever after? Perhaps. One's interest in the genetically pre-programmed states of sublimity sketched in The Hedonistic Imperative is tempered by the knowledge that one is unlikely to be around to enjoy them. It's all very well being told our descendants will experience every moment of their lives as a magical epiphany. For emotional primitives and our loved ones at present, most of life's moments bring nothing of the sort. In centuries to come, our emotional well-being may indeed surpass anything that human legacy wetware can even contemplate. Right now, however, any future Post-Darwinian Era of paradise-engineering can seem an awfully long way off. Mainstream society today has a desperately underdeveloped conception of mental health. There's clearly a strong causal link between the raw biological capacity to experience happiness and the extent to which one's life is felt to be worthwhile. High-minded philosophy treatises should complicate but not confuse the primacy of the pleasure-pain axis. So one very practical method of life-enrichment consists in chemically engineering happier brains for all in the here-and-now. Yet how can this best be done? Any strategy which doesn't subvert our inbuilt hedonic treadmill of inhibitory feedback mechanisms in the CNS will fail. Political and socioeconomic reforms offer at best a lame stopgap. To the scientific naturalist, all routes to happiness must ultimately be biological - "culture" and "talk-therapy" alike must be neurochemically encoded to exert any effect on the psyche. Some of these routes to happiness involve the traditional environmental detours. They are too technical, diverse and futile to tackle here. If the quality of our lives is to be significantly enhanced in the long term, then the genetically predisposed set-point of our emotional thermostats needs to be recalibrated. The malaise-ridden norm typically adaptive in humanity's ancestral environment must be scrapped. So while we wait until germ-line gene-therapy to promote mental super-health can become standard, it's worth considering instead how ordinary early 21st Century Homo sapiens can sustainably maximise emotional well-being with only present-day pharmacology to rely on. No

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less importantly, how is it possible to combine staying continuously "better than well" with retaining one's sense of social and ethical responsibility to other people and life-forms? Extracting reliable information on this topic is extraordinarily difficult for laity and professionals alike. The layman is more likely to be given heavily slanted propaganda. Unvarnished fact might confuse his supposedly uneducated and functionally diminutive brain. Careerscientists, on the other hand, are bedevilled by a different problem. Access to funds, laboratories, raw materials, journal publication, professional preferment, and licenses to conduct experimental trials is all dependent on researchers delivering results their paymasters want to hear. The disincentives to intellectual integrity could scarcely be greater; and they are cloaked in such reputable disguise. By way of illustration, it's worth contemplating one far-fetched scenario. How might an everlasting-happiness drug - a drug which (implausibly!) left someone who tried it once living happily-ever-after find itself described in the literature? "Substance x induces severe, irreversible structural damage to neurotransmitter subsystem y. Its sequelae include mood-congruent cognitive delusions, treatment-resistant euphoria, and toxic affective psychosis." Eeek! Needless to say, no responsible adult would mess around with a potent neurotoxin under this description. Several excellent researchers play the game by the rules. They keep their heterodox opinions to themselves. Others find such cognitive dissonance too unpleasant. So they gradually internalise the puritanical role and tendency to warped scientific prose expected of them. [Whereas tortured non-human experimental animals, for instance, blandly get "used" and "sacrificed", certain socially taboo drugs always get "abused" by "drug-abusers"] On the other hand, some of the most original and productive minds in the field of psychopharmacology - pre-eminently Alexander Shulgin - have already been silenced. Many more careers have been intellectually strangled at birth or consigned to professional oblivion. The danger of poisoning the wells of information, for whatever motives, is straightforward. When young people discover they have been lied to or deceived, over cannabis for instance, they will pardonably assume that they have been lied to or deceived over the dangers of other illegals too. And this, to put it mildly, would be exceedingly rash. Most recently, the Internet daily delivers up an uncontrollable floodtide of fresh ideas to counter official misinformation. Some of the online literature, for instance Erowid, is first-rate. At its best, Wikipedia puts print publications to shame. Unfortunately, a lot of web-published

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material isn't much more objective in content or style than the professional journals it complements. Medical ghostwriting, unacknowledged conflicts of interest and publication bias are endemic to "peer-reviewed" academic journals; but methodological rigour is scarce in the scientific counter-culture too. Devising one's own system of filtering and quality-control to drown out the noise is a challenging task for anybody.

SOME DEAD ENDS One spectacularly incompetent route to a lifetime of happiness involves taking unsustainable psychostimulants such as cocaine or the amphetamines. In the short term, their activation of the sympathetic nervous system tends to elevate mood, motivation and energy. Users tend to talk a lot. Self-confidence is enhanced: these are "power drugs". Physical strength and mental acuity are variably increased. Whereas cocaine blocks the neuronal re-uptake of the catecholamine neurotransmitters noradrenaline and dopamine, amphetamine triggers to a much greater extent their synaptic release. Amphetamine feels coarser, lasts longer and costs less. In either case, libertarian indignation that the State presumes to subject its citizens to totalitarian-style mind-control should not obscure the fact that for most purposes these are not useful drugs. This is because the central nervous system supports a web of mutually inhibitory feedback-mechanisms. In response to a short-term increase of moodmediating monoamines in the synapses, the genes and neuronal receptors re-regulate. So at best no real long-term benefit is derived from the use of such compounds. Neither cocaine nor amphetamine yield the sustained activation of intracellular signal-transduction cascades needed to cheat the hedonic treadmill and keep us truly happy. Some people continue to take psychostimulants casually for years without serious harm. Yet the potential risks of adverse physical, psychological and social ill-effects are high. Their use beyond narcolepsy and perhaps ADHD is best discouraged. The "depressant" opioids are somewhat more benign. They are effective painkillers. Opioids can also be extremely pleasurable. In classical antiquity, Aristotle - admittedly not always the soundest authority on medical matters - classified pain as an emotion. Opium was a traditional remedy for melancholic depression; its efficacy is arguably superior to Prozac, though comparative controlled clinical trials are lacking. In "animal models", opioids reverse the depressed behaviour, learned helplessness and neuroendocrine responses associated with clinical depression. By contrast, opioid antagonists such as naloxone

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exacerbate them. To confuse matters further, sufferers from depression typically share an increased sensitivity to pain; and modern "antidepressants" can themselves act as "physical" painkillers. Conversely, mu-opioid receptor agonists offer both unsurpassed painrelief and extraordinary emotional well-being; and delta-opioid agonists and enkephalinase inhibitors can function as antidepressants. There is clearly an intimate link between "physical" and "emotional" pain. In defiance of dualist metaphysics, opioids tend to be good at banishing both. Contemporary medical orthodoxy classifies drug-induced bliss as an "adverse side-effect" of opioid analgesics - even in the terminally ill. Yet we could all do with having our native endorphin systems enriched. Later this century and beyond, the customised site-selective successors to today's opioid drugs may play a critical role in promoting emotional super-health. For example, one of the most exciting research breakthroughs in recent years has been the synthesis of JDTic. JDTic exerts a sustained anti-anxiety and mood-brightening effect: it is the first orally active selective kappa opioid antagonist. Kappa is the "ugly" opioid receptor whose endogenous ligand is dynorphin. The dynorphin/kappaopioid receptor system is implicated in the unpleasant states of mind caused by chronic uncontrolled stress. Repeated use of cocaine, heroin, ethyl alcohol and other euphoriant drugs induces a compensatory upregulation of the dynorphin/kappa-opioid receptor system too, causing anxiety, anhedonia and dysphoria. Whereas mu receptor agonist opioids induce euphoria by enhancing dopamine release in the nucleus accumbens, activation of kappa opioid receptors inhibits dopamine release from the mesolimbic terminals. This deficiency is subjectively unpleasant because the mesolimbic dopamine system regulates hedonic tone and the capacity to experience (and anticipate) happiness. Dopamine also modulates the threshold of pain perception. As of 2011, controlled clinical trials of JDTic or its analogues (e.g. zyklophin) in humans have yet to begin. But results in non-human "animal models" are encouraging. In July 2011, the world's first conference dedicated to kappa opioids and antagonists, Kappa Therapeutics, was held in Seattle. Unfortunately, opioids in present-day human use are flawed. Taken at fixed dosage, they lose some of their euphoriant and analgesic effect as tolerance sets in; opioid drugs are physiologically addictive. Overdoses can cause respiratory depression; by contrast, physical pain is a potent respiratory stimulant. When taken recreationally, opioids inspire a dreamily contented disengagement from the problems of the world. Their use diminishes our drive to constructive activity as consumers in today's competitive global marketplace. More insidiously, excess consumption of narcotics inhibits the release of endogenous opioids normally induced by social interaction with friends and family. By diminishing the craving for

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human companionship, the addict substitutes one form of opioid addiction for another. Thus junkies are usually "selfish". The physical risks of opioid use shouldn't be exaggerated. Most of the problems that users suffer ultimately derive less from their choice of drug itself than from the illegal status of narcotics in prohibitionist society. Yet even if opioid drugs were legal and given away in cereal packets, such drugs wouldn't make a good choice of mood-booster - or at least not in their present, crudely non-specific guise. Kappa receptor agonists, for instance, impair dopamine function. They have dysphoric and psychotomimetic effects: one might as well drink ethyl alcohol spiced with meths. The paradise-engineers of posterity will surely weed out such adulterants from their elixirs altogether. By contrast to today's opioids, marijuana isn't usually addictive in the traditional sense of the term. It can still be habit-forming. Marijuana has euphoriant, psychedelic and sedative properties. Experiments with stoned rats suggest that cannabis use reduces the amount of corticotrophin-releasing factor (CRF) in the amygdala. Excess secretion of CRF is associated with abnormalities in the HPLA axis and depression. The rebound surge of CRF on ceasing cannabis-use correlates with increased vulnerability to stress and a withdrawal-reaction, arguably one good reason not to stop in the first instance. Stress-induced endocannabinoid deficit in the brain may induce melancholic depression in users and nonusers alike. A dysfunctional response to stress, linked to a chronically overactive HPLA axis, causes anxiety disorders and depression; CRH-type 1 receptor antagonists like antalarmin are being investigated as potential anxiolytics and antidepressants. The deeper roots of our malaise lie buried in the evolutionary past. The primary psychoactive ingredient in marijuana is THC, tetrahydrocannabinol. Smoking or eating marijuana and its complex cocktail of compounds may rarely trigger episodes of depersonalisation, derealisation and psychosis. Sometimes it can induce paranoia, particularly in advocates of The War Against Drugs. More commonly, marijuana just leaves the user pleasantly and harmlessly stoned. It's fun. Sleepiness, pain-relief and euphoria are typical responses. Cannabinoid CB(1) receptor agonists are potential antidepressants. Indeed cannabinoids may be neuroprotective against the effects of stress. Conversely, cannabinoid CB(1) receptor antagonists/inverse agonists, like the new EC-licensed diet-drug rimonabant (Acomplia), may cause depression and anxiety. Indeed the first brain-derived substance found to bind to our cannabis receptors was christened "anandamide", a derivative of the Sanskrit word for internal contentment. Getting high may thus serve as an innocent recreational pastime in an uncaring world. Yet marijuana is not a wonderdrug. Cognitive function in the user is often impaired, albeit moderately and reversibly. Marijuana interferes

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with memory-formation by disrupting long-term potentiation in the hippocampus. One of the functions of endogenous cannabinoids in the brain is to promote selective short-term amnesia. Forgetting is not, as one might have supposed, a purely passive process. Either way, choosing deliberately to ingest an amnestic agent for long periods is scarcely an ideal life-strategy. It's especially flawed given the centrality of memory to human self-identity. Some artists and professional bohemians, it is true, apparently do find smoking grass an adjunct to creative thought. For persons of a more philistine temperament, on the other hand, it's hard to see such a drug as a major tool for life-affirmation or the development of the human species. This shortcoming does not, one ought scarcely need to add, suggest marijuana users should be persecuted and criminalised. Indeed the marijuana compound THC may actually be superior to commercially licensed products at blocking the formation of mind-rotting amyloid plaques of the memory-destroying Alzheimer's disease. The disparate drugs we label psychedelics - lysergamides like LSD25, tryptamines like DMT and psilocybin, and phenethylamines such as mescaline - are sometimes exhilarating. At best, they are lifetransforming and soul-enriching. They can certainly be mind-wrenching. Taking major psychedelics can generate experiences too outlandish for our normal conceptual framework to accommodate. We haven't even names for the strange new modes of perception, selfhood and introspection their biochemical pathways disclose. Unfortunately, one cant look after the kids, fill in ones tax forms or carry out ones social responsibilities while tripping on LSD. Psychedelics are typically too bizarre, exotic and ineffable in their effects to integrate into the rest of ones life. By trapping most of us in "ordinary" waking consciousness, selfish DNA stumbled on a cunning trick to help its vehicles leave more copies of itself. Worse, the psychedelics aren't primarily euphoriants. They dont directly stimulate the pleasure-centres and guarantee the user a good trip. Both the serotonin- and catecholamine-like families trigger psychedelia mainly via their role as partial agonists of the 5-HT2A receptors in the central nervous system; 5HT2 heteroreceptors exert a tonic inhibitory effect on the striatal dopaminergic neurons. Such agents arent a dependable choice of clinical or recreational mood-brightener, whether in the short- or long-term. Depressives, neurotics and other troubled souls in search of enlightenment are most likely to undergo nightmarish freak-outs. Psychotic derealisation isn't illuminating - or fun. The drug-nave mind cant make an informed prior choice of whether to explore radically altered states. For aspiring psychonauts cant know, in advance, the true nature of what they may be choosing - or missing. Ultimately, when our well-being is genetically hardwired and invincible, psychedelia can be safely explored. The study of consciousness

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can become an experimental discipline. The synthesis of tomorrows designer-psychedelics may unleash an intellectual revolution without precedent. Until then, psychedelic drugs are too unpredictable - and our dark, Darwinian minds are too poisoned - responsibly to promote their use. Apparently by contrast, the empathogen "hug-drug" Ecstasy (methylenedioxymethamphetamine; MDMA) offers a wonderfully warm, sensuous, loving, and empathetic peak experience to the first-time user "a brief fleeting moment of sanity" [Dr Claudio Naranjo]. MDMA enhances the release of serotonin and dopamine at the synaptic terminals; it also inhibits their reuptake. MDMA stimulates pro-social oxytocin release via activation of the serotonin 5-HT1A receptors. In consequence, distrust, suspicion and jealousy evaporate. They are replaced by a serene sense of universal love. The sensorium remains clear. Emotion is intensified. Much recreational drug-use tends to be self-centred. Drug use is often branded as selfish. Yet here is a "penicillin of the soul" which promises to subvert our DNA-driven tendency to self-aggrandisement. Disappointingly, whether due to enzyme-induction or other causes not fully understood, most users never fully recapture the magic of their first few trips. Moreover, Ecstasy is neurotoxic to serotonergic axons. It may even be harmful at sub-therapeutic doses. As the uncertain process of neural recovery sets in, heavy users in particular may experience the subtle long-drawn-out reversal of all the good effects they initially enjoyed from the drug. Taking a post-trip selective serotonin re-uptake inhibitor (SSRI) such as fluoxetine (Prozac) 2-6 hours afterward is prophylactic against the measurable post-E serotonin dip otherwise experienced some 48 hours later. Yet taking SSRIs on a regular basis largely nullifies the already attenuated benefits of prolonged Ecstasy use. In any case, the duration of the peak E experience is a mere 90 minutes. So taking Ecstasy scarcely amounts to a full-scale strategy for life either. Ecstasy does, on the other hand, deliver an exquisite foretaste of the beautiful forms of consciousness that ultimately await us. Another tantalising and deliciously sensuous hint of the sublime is offered - infrequently and unpredictably - by gamma-hydroxybutyrate (GHB). GHB usually takes the form of a clear, odourless, slightly saltytasting liquid. In the brain, the GHB molecule is also an endogenous precursor and metabolite of the inhibitory neurotransmitter GABA. GHB is non-toxic; but it mustn't be mixed with alcohol or other depressants. It's metabolised quickly to carbon dioxide and water. GHB's steep doseresponse curve means nave users run the severe risk of falling asleep. When used lightly in recreational rather than stuporific or anaesthetic doses, GHB is a touchy-feely compound which typically induces deep muscular relaxation, a sense of serenity, and feelings of emotional warmth. Often it enhances emotional openness and the desire to

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socialise. Tactile sensitivity and the appreciation of music are enriched. Most remarkably, the moderate user may awake refreshed after a deep restful sleep: GHB appears temporarily to inhibit dopamine-release while increasing storage, leading to the brightened mood and sharpened mental focus of a subsequent "dopamine-rebound". GHB acts both as a disinhibitor and an aphrodisiac. Intensity of orgasm is heightened. Hence GHB is potentially useful in relieving the psychopathologies of prudery and sexual repression. Unfortunately, its therapeutic value has been eclipsed by its demonisation in the mass-media. Stories of chaste virgins turning into sex-crazed nymphomaniacs make great copy and poor scientific medicine. Moreover GHB is sometimes confused with the amnestic "daterape" benzodiazepine, flunitrazepam - better-known as the potent and fast-acting sedative-hypnotic "forget pill", Rohypnol. Bought on the street, GHB may be confused with all sorts of other substances too. Yet even pure GHB is no magic elixir. Not everyone likes it. GHB's psychological effects are unpredictable and poorly understood. It has a relatively low therapeutic index. Nausea, dizziness, inco-ordination are common; reaction-time is slowed. GHB does not usually promote great depth of thought. Its very status as "an almost ideal sleep inducingsubstance" makes it of limited use to those who aspire instead to be more intensely awake. The lack of any discernible body-count to fuel the periodic moral panics its use induces may allow a partial rehabilitation. Yet GHB evokes - at best - only a faint, fleeting parody of the life-long chemical nirvana on offer to our transhuman successors. Ethyl alcohol - the traditional date-rape drug of choice - and, most insidiously of all, cigarettes are the really sinister mass-killers. A report published in The Lancet in March 2007 ranked alcohol and tobacco as more hazardous to human health than LSD. Their cumulative human death-toll to date is around 100 million and climbing. A WHO report published in February 2008 projected that tobacco abuse may kill one billion people by the year 2100. With that poker-faced Alice-InWonderland logic popular amongst the world's sleazier governments, not merely do the authorities preserve the legal status of cigarette sales here in the UK on grounds of upholding personal liberty. The slickly expensive marketing and glamorisation of tobacco products to potential victims is sanctioned on similar grounds too. We ought to be as shocked at tobacco promotion as we'd certainly feel if instead the billboards urged kids to try heroin because it's cool. Yet familiarity breeds moral apathy. Youngsters are typically hooked before they are in any position to make an informed choice of their preferred poison - or even to abstain altogether. Meanwhile a state-supported export drive targets the poor in vulnerable Third World countries. With a cynicism that almost beggars belief, one celebrated British ex-Prime Minister accepted a million-dollar bribe from a leading member of the drug-cartels for her services. Her party's Home Secretary then delivered himself of blood-curdling calls for a crack-down on evil

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drug-pushers(!). He went on to increase the draconian penalties already available for personal users of cannabis. So long as our governments collude with the tobacco drug cartels to share out the billions of dollars of tax revenues mulcted from nicotineaddicts - thereby keeping direct taxes visibly down and themselves visibly in office - there seems little hope of a more intelligent approach to psychoactive drugs as a whole.

DIRTY MOOD BRIGHTENERS The commonly recognised legal and illegal recreational drugs offer poor prospects for sustained biological mood-enhancement. So what about the heterogeneous group of compounds uninvitingly labelled as anxiolytics and antidepressants? Have they potentially anything significant to add to most people's quality of life? Official medical doctrine says no. Allegedly, only sufferers from clinically-sanctioned psychiatric disorders will benefit from such agents - though in recent years it has at last been formally recognised that depressive disorders are under-diagnosed and undertreated even by the early twenty-first century's abjectly poor standards of acceptable ill-being. Most of humankind, however, still doesn't fit any of the official diagnostic boxes. So can "diagnostic creep" triumph over therapeutic minimalism and enhance our quality of life? Yes. Must the goal of pharmacotherapy be as limited as Freud's aspiration for psychotherapy: "to transform hysterical misery into common unhappiness"? No. First, the boring but crucial preliminaries. Optimal nutrition and aerobic exercise will increase the efficacy of all the potential lifeenhancers touted here. A rich supply of precursor chemicals (e.g. ltryptophan, the rate-limiting step in the production of serotonin) can also reduce their effective drug dosages. By choosing to eat an idealised "stone-age" diet rich in organic nuts, seeds, fruit and vegetables, and drastically reducing one's consumption of saturated fat (red meat, fried foods), sugar (sweets etc) and hydrogenated oils (found in margarine and refined vegetable oils), then one's baseline of well-being - or at least relative ill-being - can be sustainably lifted. There is mounting evidence too that an omega-3 fatty acid-rich diet or supplementation is protective against depression and other psychiatric disorders. Folic acid augmentation is advisable as well. Visitors to HedWeb probably don't expect to be assailed by sermons on the benefits of exercise any more than food-faddism. Yet regular and moderately vigorous physical exertion releases endogenous opioids, enhances serotonin function, stimulates nerve growth factors, promotes cell proliferation in the hippocampus, and leads to a livelier, better-oxygenated brain.

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Alas, clean living and wholesome thoughts typically aren't enough. We need stronger medicine to flourish. At first glance, however, the standard, State-rationed chemicals aren't a brilliant bunch. The so-called minor tranquillisers, benzodiazepines such as diazepam (Valium), chlordiazepoxide (Librium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and the shorter-acting sedative-hypnotic temazepam (Restoril), are useful but still dreadfully crude anti-anxiety agents. Several benzodiazepines are of natural origin: diazepam, for instance, can be found in the potato. Benzodiazepines act primarily on the GABA (gamma aminobutyric acid) receptor complex. GABA functions as the main inhibitory neurotransmitter in the central nervous system. GABA is made from the main excitatory neurotransmitter, glutamate. The progress of molecular biology and neurogenetics in unravelling the fiendish complexity of GABA's receptor sub-types should eventually allow more targeted compounds to be developed. Ideally, these more selective and site-specific drugs will lack the sedative, amnestic and hypnotic properties of today's brands. Activation of GABA(A) receptors containing the alpha 1 subunit is responsible for benzodiazepine-induced sedation and memory deficits. It is hoped that newly-synthesised agonists selective for the alpha 2 GABA(A) receptor subtype may finally deliver a non-sedating antianxiety drug. Merck's investigational L838,417 is one such candidate. Human trials are eagerly awaited. The first non-benzodiazepine, nonsedating/amnesiac drug of its class to reach the market may prove to be DOV Pharmaceutical's ocinaplon. Ocinaplon is a GABA alpha-2 modulator. It exerts its anti-anxiety effect at doses (allegedly) substantially lower than doses that induce measurable sedation, amnesia, muscle relaxation and incoordination. Ocinaplon is in phase III clinical trials for anxiety (summer 2005; temporarily(?) suspended August 2005). In the meantime, currently licensed benzodiazepines tend to induce dependence, impair memory and psychomotor performance, dull consciousness and cloud the intellect. The saving grace of benzodiazepines is the weak tolerance of their anxiolytic effect. Yet there's not much chance of radical life-enrichment here, for now at least. Buspirone (Buspar) might seem more promising. It acts to desensitise the inhibitory autoreceptor 5-HT1A subtype of serotonin receptor, thereby modulating serotonin release and (sometimes) promoting a brightening of mood. Thus buspirone can be useful in anxious depressive states. Its active metabolite 1-PP is an anxiolytic 5-HT1A partial agonist too. Buspirone lacks the intellect-clouding effects of other clinical and alcoholic anti-anxiety agents. It's not a muscle relaxant. It's only mildly sedating. Yet buspirone's weak and equivocal effects on subtypes of dopamine function, while useful commercially for the purposes of touting its lack of "abuse-potential", mean buspirone isn't very exciting or popular. Crucially, unlike the benzodiazepines, it's not a fast-acting drug.

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Several weeks of use may pass before its dubious psychological benefits are felt. Researchers hope that newer 5-HT1A agonists in the pipeline will be more effective. Alas any therapeutic gain is likely to be modest. In June 2004, the FDA determined that Organon's gepirone (Ariza) was "not approvable". In February 2007, GlaxoSmithKline and Fabre-Kramer Pharmaceuticals announced an exclusive worldwide agreement for the development and commercialisation gepirone ER. A FDA review of its use for major depressive disorder is anticipated in 2009. Oxytocin is a natural anti-anxiety agent: the "cuddle hormone". Several drug companies, notably Wyeth, are investigating its patentable synthetic analogues. Enhanced oxytocin release contributes to the acute pro-social action of MDMA (Ecstasy). Oxytocin builds trust by reducing activity in the fear-processing circuitry of the amygdala. Taken off-label, oxytocin can be inhaled as an intranasal spray to combat social phobia. It reduces shyness and normal social anxiety. More controversially, oxytocin can be applied as an odourless body-spray to manipulate the responses of other people: "trust in a bottle". Nature's social peptide is also critical to pair-bonding. In future, mastery of the oxytocin system may allow us to control our degree of fidelity and attachment to each other far more effectively than marriage vows. The sociological implications of the widespread use and abuse of "social Viagra" would be far-reaching. It should be stressed that research into the safe and sustainable enrichment of human oxytocin function has barely begun. The ill-assorted drugs we today call antidepressants fall into several categories. Their delayed-onset mood-brightening effect is correlated with alterations in the concentration of catecholamines and/or serotonin in the central nervous system, long-term receptor re-regulation, activation of specific transcription factors regulating gene expression, and new nervecell growth in the hippocampus. In the first decade of the 21st century, older monoamine theories of depressive illness popular among researchers over the past 40 years have been eclipsed by the neurogenic hypothesis of depression and antidepressant action. The neurogenic model interprets depression, at least in its more severe forms, as a neurodegenerative disorder. Chronic uncontrolled stress causes oversecretion of gluocorticoid hormones, notably cortisol. Cortisol activates the glucocorticoid receptors that regulate metabolism, inflammation and immunity. An excess of glucocorticoid hormones reduces the rate of new brain cell-proliferation in the hippocampus. The hippocampus has the highest density of receptors for glucocorticoids in the brain. Stress-induced activation of the glucocorticoid receptors causes nerve cell death and dendritic atrophy in the hippocampus; by contrast, there is synaptic growth in the basolateral amygdala. The amygdala stores memories of emotional experiences - frequently fearful and unpleasant memories. Eventually, however, prolonged stress tends to atrophy the amygdala too. These long-term changes in brain morphology

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lower mood. They may result in anhedonia and depression in the genetically vulnerable. Antidepressants either diminish, prevent or (ideally) reverse stress-induced neural damage and impaired structural plasticity. How do they really work? Despite an explosive growth in neurobabble, no one knows. The tricyclics, prototypically imipramine (Tofranil), and their allies are relatives of the neuroleptic drug chlorpromazine. Chlorpromazine is also known as Largactil, the notorious "chemical cosh". Tricyclics block to varying degrees the reuptake of serotonin and noradrenaline into the nerve cell terminals from where they are released. The consequent changes in pre- and post-synaptic receptor sensitivity may lighten the spirits of 60-70% of the depressives who take them. Perhaps unsurprisingly given their parentage, the tricyclics are all dirty drugs, though some are dirtier than others. Their anti-cholinergic effects harm memory, concentration and intellectual performance. Their anti-histamine action induces drowsiness and sedation. Their adverse effect on cardiac function makes them dangerous in overdose. Most "euthymic" volunteers on whom they have been tested don't like their dulling effects of consciousness. Unlike chlorpromazine, the tricyclic antidepressants don't noticeably block the dopamine receptors. But with one notable exception, they do precious little to stimulate dopamine function either. Hence they're not much fun even for the severely depressed people who can benefit from taking them. For three decades they were the mainstay of the treatment of clinically-acknowledged depression. They contributed to the widely-held medical opinion that anything classed as an antidepressant won't help "normal" people; unless of course they were "really" depressed. Basically, tricyclics are cheap, nasty and usually best avoided. Better, but still deeply flawed, are the selective serotonin reuptake inhibitors [SSRIs]. Serotonin, "the civilising neurotransmitter", plays a vital role in mood, memory, appetite, sleep, pain perception and sexual desire. Fluoxetine (Prozac), fluvoxamine (Luvox, Faverin), paroxetine (Paxil, Seroxat), sertraline (Zoloft, Lustral), and citalopram (Cipramil, Celexa) are currently licensed and marketed. More of their tweaked and enhanced relatives are on the way from pharmaceutical companies eager for a lucrative piece of the action. In a triumph of marketing hype and creative use of patent law if not clinical need, citalopram's S-enantiomer was FDAlicensed in 2002 as "Lexapro". The SSRIs all differ in their half-lives, chemical structure and precise specificities. Their functional effects are broadly similar, though Prozac is the most activating, longest-lasting, least selective and most likely to provoke dose-related akathisia; paroxetine has anticholinergic and sedating antihistaminergic effects; fluvoxamine most commonly induces nausea and has the shortest halflife; and citalopram is the most serotonin-selective. The mood-

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brightening, resilience-enhancing and anti-anxiety properties of the SSRIs really can make a (very) modest percentage of the population feel "better than well". Unpredictably, other users feel worse. As a class, SSRIs (mostly) don't have the physically unpleasant and cognitively debilitating anticholinergic effects of the tricyclics. SSRIs don't demand the dietary restrictions of the MAOIs. Their dependence potential and withdrawal reaction is usually milder than the opioids. The (sometimes) beneficent properties of the SSRIs are celebrated in Peter Kramer's contemporary classic Listening to Prozac. Kramer has written a remarkably honest book. It's a discursive memoir by a therapist who is forced to admit that many of his clients seemed rapidly to fare far better on a pill than on his industrial-strength regimen of caring talktherapy. Kramer's discussion of "cosmetic psychopharmacology" and "designer personalities", however, enraged traditionalists. For chemical Calvinist orthodoxy finds the notion that people should have a right to choose pharmacologically who and what they want to be profoundly offensive. In Against Depression, published in May 2005, Kramer argues that depression should be eradicated altogether. Two common problems limit the usefulness of SSRIs, at least when taken on their own. The problems stem from the indirect inhibitory effect sometimes exerted by Prozac-style drugs on dopamine function, a consequence of deliberate selective targeting of the serotonin system.

First, SSRIs can compromise libido and sexual performance. This isn't always a disadvantage in overexcitable young males; indeed the currently unlicensed SSRI dapoxetine may shortly be marketed as an ondemand treatment for premature ejaculation. But SSRIinduced sexual dysfunction can still be a highly distressing phenomenon for older people too embarrassed to talk about it. Technical performance difficulties can sometimes be counteracted by taking the blood vessel dilators apomorphine or phentolamine; the alpha2-adrenergic antagonist yohimbine; a phosphodiesterase type-5 inhibitor like sildenafil (better known as the sexual rocket-fuel Viagra), long-acting tadalafil (Cialis) or newly licensed vardenafil (Levitra); or a dopamine agonist, licit or otherwise, before bedtime action. Investigational drugs that heighten female sexual arousal (e.g. flibansein, or melanocortin agonists like PT-141/bremelanotide) are another option. Indeed, unlicensed use of the world's first aphrodisiac and inhalable sex-drug may herald a cultural revolution without precedent. Yet polypharmacy is scarcely an ideal solution for existing SSRI users. One of the major

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signs of depression is loss of interest in sex and reduced libido. So it's questionable whether the FDA and the pharmaceutical industry should continue to promote serotonergic "antidepressants" that are anti-sexual; and collude to suppress antidepressants that are pro-sexual. Second, though a few subjects may feel mildly euphoric, in other users the SSRIs serve more as mood-stabilisers and mood-flatteners in their lives. By increasing the user's emotional self-sufficiency, too, SSRIs may subtly change the "balance of power" in personal relationships - for good or ill. In some cases, SSRIs may even act as thymoanaesthetisers which diminish the intensity of felt emotion; by contrast, a mood-brightening serotonin reuptake-enhancer like tianeptine (Stablon) may intensify emotion instead. Affective flattening may be welcome to someone in the pit of unmitigated clinical depression. It is scarcely a life-enriching property for "normal" people who lack any convenient diagnostic category which acknowledges their malaise.

A backlash against SSRIs is now gathering pace. In February 2008, a Public Library of Science meta-analysis of four commonly prescribed "second generation" antidepressants - using both published and withheld drug-company data - reported that SSRIs were scarcely more effective as antidepressants than placebos. The illustrious UK psychopharmacologist Professor David Healy delivers an even more damning verdict on contemporary psychiatry: "there is probably no other branch of medicine where the outcomes for a core disease are steadily worsening." [p. 95; Shock Therapy by Edward Shorter and David Healy (2007)] THE DOPAMINE CONNECTION What's missing, crucially, is the therapeutic enrichment of hedonic tone via a combination of mu opioid pathway enhancement and prolonged stimulation of meso(cortico-)limbic dopamine function. This is really much more fun than it sounds. Yet the socially responsible use of reward pathway enhancements/remedial therapies is a technical, bioethical and medico-legal minefield. Complications aside, the currently available experimental evidence has persuaded many - but not all - investigators that the mesolimbic dopamine system serves as the final common pathway for pleasure in the brain. Enhanced responsiveness of post-synaptic dopamine D2/D3 receptors is vital to long-term emotional well-being. Insofar as they work, all "serotonergic" and "noradrenergic" mood-brighteners eventually act on the mesolimbic dopamine pathway, albeit in differing degrees and with varying delay. Even SSRIs depend on sensitization of the mesolimbic dopamine D2 receptors for their (modest) mood-lifting effect. New anti-Parkinsonian

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agents, notably the neuroprotective dopamine D3 receptor subtype selective pramipexole (Mirapex), ropinirole (Requip), and cabergoline (Dostinex) owe their potential role as fast-acting pro-sexual antidepressants to their dopaminergic action. Likewise, the possible mood-brightening effect of low doses of the dopamine receptor antagonist amisulpride (Solian), more commonly considered an antipsychotic agent, is explicable because amisulpride preferentially blocks the presynaptic dopamine D2/D3 autoreceptors; dopaminergic transmission is thereby enhanced. The full story is inevitably complex. Dopamine agonists and reuptake inhibitors are often inadequate long-term mood-brighteners by themselves. The mesolimbic dopamine system mediates rewardsignalling, incentive salience and a sense of urgency and significance, not the essence of pure bliss. Dopamine isn't itself the magic pleasurechemical, though its functional role in conjunction with glutamate and mu opioid agonists in regulating medium spiny neurons of the rostromedial shell of the nucleus accumbens is critical. Researchers into affective disorders can prematurely become over-attached to one particular neurotransmitter system, its receptor sub-types and their signaltransduction cascades. Traditionally, serotonin and noradrenaline have attracted the fiercest rival partisans in antidepressant research. "Dopaminergic" (and opioid) agents, by contrast, are suspect. They are politically incorrect since they are potentially "abusable". Moreover it can be argued that the research and development of safe and sustainable Ecstasy-like empathogens and sociabilisers is at least as morally urgent as the license of safe and sustainable euphoriants. At any rate, enhanced mesolimbic dopamine release, exclusively or otherwise, enriches the intensity of experience; increases pleasure and libido, and potentially boosts cognitive performance. Even better, whereas some dopaminergics are potentially toxic, some dopamine-enhancing agents may have neuroprotective properties as well. So what are the other contemporary options for chemical lifeenhancement? METHYLPHENIDATE (RITALIN); MINAPRINE (CANTOR); NOMIFENSINE (MERITAL) A SSRI can be combined ("augmented" sounds more soothing to the official medical ear) with a dopaminergic such as methylphenidate. As Ritalin, methylphenidate is prolifically dispensed to American schoolchildren for different purposes altogether. It is sometimes abused as an instrument of social control. In spite of its structural relationship to amphetamine, methylphenidate resembles in many ways a more benign version of cocaine, yet with a much longer half-life. Methylphenidate blocks the reuptake of, but doesn't significantly release, the catecholamines noradrenaline and dopamine. If it is taken in sustained-

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release form or combined with an SSRI, all of which have anti-obsessivecompulsive properties too, then the likelihood of dose-escalation is minimised. In Europe and North America, students sometimes take Ritalin to gain a competitive edge in exams. However, its long-term effect on the developing brain is poorly understood. Chewing coca leaves with a dash of powdered lime is a nutritious and energising way to sustain healthy mood. Unfortunately, it's illicit and not very good for one's teeth. A more cautious but still interesting option might be minaprine (Cantor). Minaprine blocks the reuptake of both dopamine and serotonin. It is also in some degree cholinomimetic. Thus it may exhibit both moodbrightening and nootropic properties. Much more research is needed. Unfortunately, minaprine is now obtainable only as a "research chemical". Merital (nomifensine) showed great promise as a pleasantly stimulating dopaminergic that also potently inhibits the reuptake of noradrenaline and - to a much lesser extent - serotonin. It was marketed by its manufacturers Hoechst with the slogan "vive la difference!" Merital was withdrawn from licensed use after the discovery of its rare side-effect of precipitating a serious blood-disorder. For retarded melancholics, however, it was typically a very effective and well-tolerated moodbrightener with minimal side-effects. The risk/reward ratio of its carefullymonitored use may have been misjudged. Nomifensine is now obtainable only as a research chemical too. BUPROPION (WELLBUTRIN); AMINEPTINE (SURVECTOR); TIANEPTINE (STABLON) Bupropion (Wellbutrin) is possibly less effective than nomifensine. Yet it's useful because it lacks the adverse effects on sexual function characteristic of the SSRIs. In some subjects - particularly women libido, arousal, and the intensity and duration of orgasm may actually increase. Bupropion weakly blocks the reuptake, but diminishes the release, of dopamine. This may account for reports of its diminished propensity to induce mania in the genetically susceptible. Bupropion's active metabolites inhibit the reuptake of noradrenaline. Radafaxine, one of these metabolites, also blocks the dopamine transporters; radafaxine may in future be marketed as a slimming drug as well as an antidepressant. Bupropion itself, branded as Zyban, may help in giving up smoking. Scandalously, bupropion isn't licensed and marketed as an antidepressant in Europe - though doctors may prescribe Zyban to nonsmoking depressives "off-label". Bupropion plus an SSRI is sometimes more effective than either agent alone. In June 2006, the FDA licensed bupropion/Wellbutrin XL as the first preventive pharmacological treatment of Seasonal Affective Disorder (SAD).

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Amineptine (Survector) is a cleanish, (relatively) selective dopamine reuptake blocker. Higher doses promote dopamine release too. Amineptine is pro-sexual and liable occasionally to cause spontaneous orgasms. It is a mild but pleasant psychostimulant and a fast-acting mood-brightener. Unlike most other tricyclics, it doesn't impair libido or cognitive function. Unlike typical stimulants and other activating agents, it may actually improve sleep architecture. Scandalously, amineptine isn't licensed and marketed in Britain and America. For it is feared it might have "abuse-potential". FDA pressure led to its withdrawal in Europe too. This drove amineptine onto the pharmaceutical grey market, discomfiting doctors and patients alike. Another "French" option is amineptine's cousin, tianeptine (Stablon). Tianeptine is a neuroprotective antidepressant that reverses the neuronal damage and lasting misery caused by uncontrolled stress. Chronic stress causes dysphoria by inducing corticotropin-releasing factor (CRF2) receptor stimulation of dynorphin release. The endogenous opioid peptide dynorphin activates the unpleasant kappa opioid receptors. Tianeptine acts both as a non-sedating anti-anxiety agent and a non-stimulating mood-brightener. Its use increases extracellular dopamine concentration in the nucleus accumbens and, at higher doses, in the frontal cortex. Uniquely in clinical medicine, tianeptine acts as a selective serotonin reuptake enhancer. Its puzzling efficacy as an antidepressant illustrates how little modern psychiatric medicine really understands about mind, mood and depression. Like other contemporary antidepressants, tianeptine's therapeutic action presumably depends on downstream adaptations both between and within neurons occurring over a period of several weeks. Chronic tianeptine use reverses stress-induced hippocampal dendritric atrophy and amgydaloid dendritic hypertrophy, which is just as nasty as it sounds. But the precise molecular mechanisms are obscure. Tianeptine/Stablon is not licensed in North America primarily because its patent has expired. REBOXETINE (EDRONAX); ADRAFINIL (OLMIFON); MODAFINIL (PROVIGIL) Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in mood, noradrenaline is essential to maintaining drive, vigilance and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha2- and beta-adrenoceptors. Reboxetine itself typically doesn't have the disruptive effects on cognitive function or psychomotor performance common to older clinical mood-brighteners though alas antimuscarinic effects are still not completely absent. Multiple interactions between the different monoamine systems make it hard to target one neurotransmitter system without triggering a cascade of effects on the others. But NorAdrenaline Reuptake Inhibitors (NARIs) -

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and dopaminergics like amineptine (Survector) - may be especially useful in drive-deficient "anergic" states where the capacity for sustained motivation is lacking; and for melancholic depressives with a poor ability to cope with stress. Reboxetine can be safely combined with an SSRI, though there is evidence that NARIs themselves indirectly enhance central serotonin function by a mechanism that doesn't depend on reuptake inhibition. More surprisingly perhaps, preliminary studies suggest reboxetine can actually reverse tranylcypromine-induced hypertensive crises. The "cheese effect" is triggered by ingesting tyramine-rich foods. Thus NARIs plus MAOIs may prove a potent form of combination-therapy if first options fail. EMSAM, the transdermal selegiline patch, is probably the safest choice of MAOI. Depressive hypersomniacs who fare poorly on SSRIs, or can't get hold of amineptine or EC-licensed reboxetine, might consider trying a socalled eugeroic ("good arousal") agent instead. Alpha1-adrenergic agonists like adrafinil (Olmifon) and modafinil (Provigil, Alertec) are centrally-acting psychostimulants that can brighten mood and sharpen mental focus. They stimulate the noradrenergic post-synaptic receptors, increase glutamatergic transmission, and activate the wakefulnesspromoting orexinergic neurons, thereby boosting alertness, memory, mood, motivation and energy. At sensible dosages, they are remarkably free of side-effects. Modafinil was licensed by the FDA as Provigil for the treatment of narcolepsy in Dec 1998; and in September 2003, an advisory panel to the FDA endorsed its use for treating shift work sleep disorder and sleep apnea. However, the significance of these prescribing indications is rapidly being eroded. Modafinil and adrafinil are now mainly used off-label as so-called lifestyle drugs. Of course, many millions of insomniacs suffer from the opposite problem. They simply want regular sleep. Supracor's new sleep-aid eszopiclone (Lunesta) can be taken on a nightly basis indefinitely. It will be the first sleeping pill not to carry an FDA warning against long-term use. MIRTAZAPINE (REMERON); NEFAZODONE (SERZONE); VENLAFAXINE (EFFEXOR) & DESVENLAFAXINE (PRISTIQ); DULOXETINE (CYMBALTA); ROLIPRAM; AGOMELATINE (VALDOXAN) NARIs are normally activating. Anxious and depressive insomniacs, on the other hand, may benefit more from "dual-action" mirtazapine; or from newly-licensed duloxetine. Mirtazapine (Remeron) is a structural analogue of the off-patent mianserin (Bolvidon). It is a comparatively new drug - a so-called NaSSA. By blocking the inhibitory presynaptic alpha2 adrenergic autoreceptors and stimulating only the 5-HT1A receptors, mirtazapine enhances noradrenaline and serotonin release while also blocking two specific (5HT2 and 5-HT3) serotonin receptors implicated in dark moods and

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anxiety. By contrast, stimulation of the 5-HT2A receptors accounts for the initial anxiety, insomnia and sexual dysfunction sometimes reported with the SSRIs; stimulation of the 5-HT3 receptors causes nausea. Unfortunately, mirtazapine is a potent blocker of the histamine H1 receptors too. So it tends to have a somewhat sedative effect. This profile may be good for agitated depressives and insomniacs. Again, it is scarcely a recipe for life-affirmation. Nefazodone (Serzone) is another "dual action", mainly serotonergic agent. It inhibits the reuptake of serotonin while displaying post-synaptic 5-HT2A-receptor antagonism. This may be useful for anxious depressives; but again, it may cause feelings of weakness, drowsiness and lack of energy. Nefazodone is less likely to cause priapism than its older cousin trazodone (Desyrel). It is less likely to cause sexual dysfunction than the SSRIs. But nefazodone can also be toxic to the liver, albeit rarely. It may soon be withdrawn altogether by its manufacturer Bristol-Myers Squibb under threat of litigation. Venlafaxine (Effexor) is a phenethylamine. Thus it's a benign if distant chemical cousin of MDMA. Its manufacturers launched it as "Prozac with a punch". In February 2008, the FDA licensed its extendedrelease active metabolite desvenlafaxine as the antidepressant Pristiq after Weyth's venlafaxine patent expired. Venlafaxine inhibits the neuronal reuptake of serotonin, noradrenaline and dopamine in descending order of potency. If dopaminergically augmented, it offers another opening for creative psychopharmacology. Such augmentationtherapy remains (almost) clinically unexplored. Taken on its own at low dosage, venlafaxine acts primarily as a serotonin re-uptake inhibitor. At the high-level dosages most suitable for melancholic and hypersomnic temperaments, its noradrenergic (and weakly dopaminergic) action becomes more pronounced. Venlafaxine lacks anticholinergic activity; but some users are troubled by its antihistamine side-effects. Like the SSRIs, it is sometimes useful for a broad spectrum of disorders beyond clinical depression. It is possible that duloxetine (Cymbalta, Xeristar, Yentreve), licensed by the FDA in autumn 2004, and milnacipran (Ixel, Dalcipran, Toledomin), available in Europe, may be more effective than venlafaxine (Effexor) for a segment of the population that can benefit from dual serotonin-noradrenaline reuptake inhibition. Pain-ridden depressives in particular may respond well to this class of drug. Many depressed people suffer from poorly-defined aches and pains, persistent fatigue, and shoulder-, neck- and back-pain. Duloxetine relieves both the somatic and emotional symptoms of depression. Unlike venlafaxine, duloxetine exerts its more balanced serotonin and noradrenaline reuptake inhibition throughout the dosage range. Duloxetine also weakly inhibits the reuptake of dopamine, and shows minimal affinity for the histamine and

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cholinergic muscarinic receptors. Its side-effect profile appears to be relatively benign. Yet an authentic wonderdrug for mental health remains elusive. Early expectations that duloxetine would show superior efficacy in melancholic depressives have not yet been convincingly borne out in controlled clinical trials. Ill-served by mainstream medicine, victims of melancholic and retarded depression may actually do better on dual noradrenaline-dopamine reuptake inhibitors such as delicensed nomifensine (Merital) and/or mu opioid agonists/kappa opioid antagonists such as buprenorphine (Temgesic, Buprenex, Subutex). Duloxetine itself will probably prove a blockbuster product. It will most likely be marketed for everything from stress urinary incontinence, social phobia and generalised anxiety disorder, diabetic peripheral neuropathic pain and possibly irritable bowel syndrome. But alas it takes time to separate genuine therapeutic advance from drug company hype, typically not until the patents expire. Phosphodiesterase-inhibitors, both selective (e.g. the PDE type 4 inhibitor rolipram) and unselective, are another under-used option. The next few decades will take us much closer to the downstream intracellular action. For it is here that our minds will ultimately be healed, genetically or otherwise. Agomelatine (Valdoxan) is a novel antidepressant and anti-anxiety agent developed by Servier and licensed in the European Union in February 2009. A synthetic analogue of the natural hormone melatonin, agomelatine is a potent melatonin receptor agonist and a serotonin 5HT2C receptor antagonist. Blockade of the neural 5-HT2C receptors enhances frontocortical adrenergic and dopaminergic transmission, potentially improving cognitive performance. In "animal models", agomelatine also reduces the adverse effects of stress on memory. By acting as a melatonin receptor agonist, agomelatine improves sleep quality. When taken once daily before bedtime, agomelatine doesn't cause daytime drowsiness and sedation like the old tricyclics; nor does its use kill libido like the SSRIs. Agomelatine is typically well tolerated and remarkably free from adverse side-effects at therapeutic dosages. Drug giant Novartis acquired the US rights to agomelatine from Servier in 2006. In July 2009, Novartis announced it was delaying submission for US regulatory approval another three years while it conducted additional Phase III trials. American consumers must now order agomelatine from Europe. HYPERICUM Hypericum is important for a different reason altogether. Many constitutionally unhappy people refuse to have anything to do with orthodox Western medicine. They won't take "unnatural" pharmaceutical products at all. In consequence, they spend much of their lives trapped in a squalid psychochemical ghetto of low spirits. The only sort of remedy

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that they'll conceivably contemplate taking must carry a "natural" label and soothingly "herbal" description. Unfortunately, most folk remedies are only marginally effective. Our drug-metabolising enzymes are the product of an evolutionary arms race to counteract plant toxins. For plants tend to manufacture psychotropics because they poison or debilitate creatures tempted to eat them - not to heal our psychic woes. The Wisdom Of Nature is a quaint piece of makebelieve. Perversely, several of the natural remedies that sometimes actually work - notably Cannabis sativa, Erythroxylon coca and Papaver somniferum - are now illegal to consume. Other "natural" interventions such as bright light therapy combined with good sleep discipline may be of limited use. But two options worth exploring are SAMe and St John's wort. Hypericum, the active ingredient in St John's wort, appears to be an effective mood-brightener and anxiolytic - by today's standards at least. Its side-effect profile and efficacy in mild-to-moderate depression compares favourably with its synthetic counterparts. Hypericum's blend of serotonin-reuptake inhibiting and (mild) MAO-inhibiting properties (not a combination otherwise to be explored with potent synthetics: the risk of the potentially fatal serotonin syndrome is too great) contributes to without wholly explaining - its generally benign effects. Once again, much more research is needed, preferably not bankrolled by the makers of lucrative competing products. Thus a German trial published in the British Medical Journal in February 2005 reported that a proprietary standardised extract of hypericum/St John's wort was more effective and a better tolerated treatment of moderate to severe depression than the SSRI paroxetine (Paxil). This runs counter to the negative findings of the 2001 U.S. trial sponsored by the makers of the SSRI sertraline (Zoloft) - which concluded that for moderate to severe depression, St John's wort was no better than a placebo. Faith in the integrity of biological psychiatry would be greater if the single strongest predictive factor in the outcome of any published clinical trial wasn't the identity of the funding body. A Cochrane Review published in October 2008 found that hypericum extracts used to treat major depression had similar efficacy to standard antidepressants but fewer side-effects. INOSITOL One further remedy, albeit at "unnatural" doses, is worth noting. Inositol levels tend to be low in depressives and high in euphoric people. Taking myo-inositol as a food supplement in doses of 12g and more per day represents perhaps the first successful use of the precursor strategy for a second messenger rather than a neurotransmitter in the search for long-term mood-brightening agents. Inositol and its derivatives serve as messenger molecules within the nervous system. The molecule itself is a naturally occurring isomer of glucose. It is a key intermediate of the

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phosphatidyl-inositol cycle. This is a second-messenger system used by several noradrenergic, serotonergic and cholinergic receptors. Adult westerners typically consume about one gram of inositol per day in their food. The richest dietary sources are fruits, nuts, beans and grains. The mood-darkening ("stabilising") effect of lithium in manically euphoric people may be explicable in terms of its inositol-depleting effect. Potentially, if taken in high doses, inositol seems to be a good way of lightening the spirits and diminishing anxiety in "euthymic" and depressed people alike. Dosages of even 50g and more reportedly produce no toxic side-effects. This regimen shouldn't be attempted unsupervised by people with a history of bipolar disorder. As usual, much more research is in order. One "problem" is that naturally-occurring compounds - such as inositol and SAMe - can't be patented. So the scope for high profitmargins is diminished. Progress is unlikely to be brisk. THE MAO INHIBITORS A further option involves using both some of the oldest and the newest drugs on the block, the monoamine oxidase inhibitors (MAOIs). The older irreversible MAOIs certainly shouldn't be combined with SSRIs. It is inadvisable to combine them with stimulants or many other drugs. Yet both old and new, the MAOIs do have some very interesting properties. MAOIs may be particularly useful for rejection-sensitive, socalled atypical depressives who have "reversed vegetative symptoms" i.e. overeating and oversleeping. Monoamine oxidase has two main forms, type A and type B. They are coded by separate genes. MAO may be inhibited with agents that act reversibly or irreversibly; and selectively or unselectively; these categories are not absolute. For instance, the beta-carboline alkaloids found in the world's most popular drink, coffee, are competitive and reversible inhibitors of both MAO type A and type B. MAO type-A preferentially deaminates serotonin and noradrenaline, and also nonselectively dopamine; type B primarily metabolises dopamine, phenylethylamine (the "chocolate amphetamine") and various trace amines. The mood-elevating properties of the MAOIs were discovered quite by chance in a US veterans' hospital early in the 1950s. Many patients given the anti-tuberculotic drug iproniazid were not merely cured of their tuberculosis. They became exceptionally happy as well. The animated enthusiasm for life of a previously crotchety bunch of old soldiers disconcerted their doctors. For it transpired that their new-found euphoria wasn't just an understandable reaction to being cured of physical disease. MAOIs typically have mood-brightening properties as well. At the time, there was no accepted and clinically effective treatment for depression. Fortunately, via the usual circuitous routes, the appropriate lessons were

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eventually drawn. Many millions of people were successfully treated with MAOIs in consequence. Sadly, the role of MAO in deaminating tyramine (from the Greek word tyros, meaning cheese) wasn't at first understood. Certain MAOItreated patients suffered hypertensive crises after eating varying amounts of tyramine-rich aged cheese; and several died. It is now recognised that the use of any MAOI which is both irreversible and unselective must be accompanied by dietary restrictions. But the adverse publicity of the initial inexplicable fatalities, combined with the introduction of a succession of dirty but sometimes tolerably effective tricyclic compounds, sent the use and reputation of MAOIs into a precipitous decline from which they still haven't fully recovered. The older non-selective and (more-or-less) irreversible inhibitors tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) are nonetheless valuable antidepressants. Outside America, the the selective and reversible MAOI moclobemide. is used too. Of greater interest still are central-nervous-system-selective compounds, notably the neuroprotective antidepressant and antiAlzheimer's drug TV3326 (ladostigil). MAOIs that lack the peripheral effects of currently explored drugs herald an exciting new window of therapeutic opportunity. SELEGILINE (l-deprenyl, ELDEPRYL, EMSAM) A recent New York study showed that smokers had on average 40% less of the enzyme, monoamine oxidase type-B, in their brains than nonsmokers. Levels returned to normal on their giving up smoking. Not merely is the extra dopamine in the synapses rewarding. The level of MAO-b inhibition smokers enjoy apparently contributes to their reduced incidence of Parkinson's and Alzheimer's disease. Unfortunately they are liable to die horribly and prematurely of other diseases first. One option which the dopamine-craving nicotine addict might wish to explore is switching to the (relatively) selective MAO-b inhibitor selegiline, better known as l-deprenyl. Normally the brain's irreplaceable complement of 30-40 thousand odd dopaminergic cells tends to die off at around 13% per decade in adult life. Their death diminishes the quality and intensity of experience. It also saps what in more ontologically innocent times might have been called one's life-force. Eighty percent loss of dopamine neurons results in Parkinson's disease, often prefigured by depression. In future, the mood-enhancing transplantation of customized stem cells may restore a youthful zest for life in dopamine-depleted oldsters: such stem cell-derived monoaminergic grafts are currently on offer only to depressed rodents. Deprenyl has an anti-oxidant, immunesystem-boosting and dopamine-cell-sparing effect. Its use boosts levels of tyrosine hydroxylase, growth hormone, superoxide dismutase and the production of key interleukins. Deprenyl offers protection against DNA

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damage and oxidative stress by hydroxyl and peroxyl radical trapping; and against excitotoxic damage from glutamate. Whatever the full explanation, deprenyl-driven MAOI-users, unlike cigarette smokers, are likely to be around to enjoy its distinctive benefits for a long time to come, possibly longer than their drug-nave contemporaries. For in low doses, deprenyl enhances life-expectancy, of rats at least, by 20% and more. It enhances drive, libido and motivation; sharpens cognitive performance both subjectively and on a range of objective tests; serves as a useful adjunct in the palliative treatment of Alzheimer's and Parkinson's disease; and makes you feel good too. It is used successfully to treat canine cognitive dysfunction syndrome (CDS) in dogs. At dosages of around 10 mg or below daily, deprenyl retains its selectivity for the type-B MAO iso-enzyme. At MAO-B-selective dosages, deprenyl doesn't provoke the "cheese-effect"; tyramine is also broken down by MAO type-A. Deprenyl isn't addictive, which probably reflects its different delivery-mechanism and delayed reward compared to inhaled tobacco smoke. In November 2004, Yale University researchers launched a study of deprenyl for smokers who want to quit tobacco. Whether the Government would welcome the billions of pounds of lost revenue and a swollen population of energetic non-taxpayers that a switch in people's MAOI habits might entail is unclear. L-deprenyl/selegiline can now be delivered via a transdermal patch. In December 2004, pharmaceutical firms Bristol-Myers Squibb and Somerset Pharmaceuticals announced they had entered into an agreement to distribute and commercialize EMSAM, the first transdermal treatment for major depression. After various delays, in February 2006 the FDA granted EMSAM a product license for the treatment of major depressive disorder in adults. EMSAM's pharmacokinetic and pharmacodynamic properties promote the inhibition of MAO-A and MAO-B in the CNS while avoiding significant inhibition of intestinal and liver MAOA enzyme. Three different strengths of EMSAM patch are currently marketed: 20mg/20cm2, 30mg/30cm2, and 40mg/40cm2, delivering daily doses averaging 6mg, 9mg and 12mg respectively. Use of the lowest dosage EMSAM 6 mg/24 hour patch calls for no dietary modification. At this dosage, MAO-A in the digestive tract is preserved at levels adequate to break down tyramine, while MAO in the brain is inhibited at levels adequate to induce an antidepressant effect. A restricted "MAOI diet" is prudently advised for the higher dosage EMSAM 9 mg/24 hr patch and the 12 mg/24 hr patch to avoid any risk of hypertensive crisis. But it's worth noting that (as of August 2011) no hypertensive crises following dietary indiscretions have been reported even in users of the high strength patches. RASAGILINE (AZILECT) Unlike deprenyl, the novel irreversible selective MAO-B-inhibitor rasagiline

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(Azilect) is not metabolized to methamphetamine or amphetamine. These trace amines are unlikely to contribute to deprenyl's neuroprotective action. Rasagiline gained an EC product license as Azilect in mid-2005 for the symptomatic treatment of Parkinson's disease. Azilect finally gained a US product license in May 2006. In August 2008, Teva announced promising results from a late-stage Phase III 18-month rasagiline trial. Parkinsonians who took a 1mg Azilect pill once a day from the start of the trial showed "significant improvement" over patients who started taking Azilect nine months later. MOCLOBEMIDE (MANERIX, AURORIX) Humans now have the capacity to choose their own individual level of activity or inhibition of the two primary monoamine oxidases. This does not quite enable the fine-tuning of personality variables with the functional equivalent of a graphic equaliser. It still represents a promising start. In MAO-inhibition, as in life, more is not always better. Excessive dosages of l-deprenyl, for instance, may actually shorten, not increase, life expectancy - at least in Parkinsonians if it's combined with l-dopa. And levels of above 80% inhibition of MAO-A may lead to a sharp and possibly unwanted fall in dopamine synthesis. Repairing Nature's niggardliness will be a priority for the decades ahead. Moclobemide (Manerix, Aurorix), the "gentle MAOI", is both a selective and reversible inhibitor of MAO-A. It marks the first RIMA to win clinical acceptance. Moclobemide lacks anti-cholinergic side-effects. It promotes the healthy growth of new neurons in the hippocampus. No dietary restrictions are needed. It is valuable as more than a moodenhancer and resilience-booster. For moclobemide is often useful in overcoming social phobia, panic disorder, obsessive-compulsive symptoms, irritability and aggression owing to the way it enhances serotonin function. (The casual use of gobbledygook such as "enhanced x function" will rightly alert the reader that many complications are being skirted or omitted. Those hungry for the greater technical detail of a nonpopular account can rest assured the literature will leave them feeling abundantly well-nourished). TRANYLCYPROMINE (PARNATE) Gentleness doesn't suit everyone. Moclobemide isn't much good at lifting deep melancholy. Tranylcypromine (Parnate), on the other hand, is one of the older and non-selective MAOIs - and is often none the worse for it. Structurally related to amphetamine, tranylcypromine is generally the most stimulating, dopaminergic and relatively fast-acting of the MAOIs. Some doctors are uncomfortable with its properties. This isn't just because of the dietary restrictions its use demands. In adequate doses, tranylcypromine tends to induce a mild euphoria even in "normal" subjects. Tranylcypromine use increases trace amines, modulates phospholipid metabolism and up-regulates GABA(B) receptors. In fact, its

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nicest effects, as for all of the compounds cited here, will vary in nature and extent from person to person. To some extent, optimal dosage and long-term drug-regimen of choice can be discovered only by (cautious) empirical self-investigation. Tranylcypromine is of course vastly preferable to the amphetamines and cocaine. Yet frequently and perversely, the more hazardous the drug, then the easier it is to get hold of in our society. The carcinogenic cocktail that carries off more people than all other toxins combined can be purchased quite legally and effortlessly at any tobacconist or newsagent. Obtaining the less lethal - but scarcely socially desirable - street opioids and psychostimulants requires a little more exertion. Yet they can still be readily purchased in pubs and clubs in all the big towns and cities. Many of the more beneficent drugs discussed here, on the other hand, are unlicensed, "investigational", or available on a prescription-only basis. They're not illegal to possess. But they are hard to obtain short of visiting countries where they're available over-the-counter or using online pharmacies of uncertain reputation. If the central principle at stake here were the preservation of a drug-free society, then some sort of totalitarian (or, more euphemistically, paternalistic) argument could be cobbled together for violating personal freedom so oppressively. Yet that's rarely the issue. For in most cases, the issue effectively amounts, not to drugs or no drugs, but to allowing people the choice to opt for better ones. Perhaps 80% of the population in Western countries currently drink ethyl alcohol or smoke cigarettes. Often they do both. Whether viewed in terms of mortality, morbidity or overall quality of life, we'd be better off if we switched to enhancing receptor sub-type selective dopaminergic, opioidergic, serotonergic and cholinergic function by the relatively safe, if crude, agents touched on here; and perhaps to the more exciting products under development. As a basic minimum, people shouldn't be legally robbed of the right to do so. This freedom of choice isn't conventional wisdom. It will be suggested that the level of medical expertise required to make informed choices exceeds that of the average layperson. A quasi-priestly medical caste wielding the power of the prescription-pad would doubtless wish to keep it that way. But the intrinsic difficulty and complexity of psychopharmacology or nutritional medicine, say, doesn't demand greater mental effort than, for instance, all those thousands of grimly unnatural hours spent by school students learning mathematics. Moreover it's far more interesting to study something palpably relevant to one's emotional well-being than something that demonstrably isn't. The notion of an education system geared to schooling people in, and for, happiness would nonetheless strike adherents of the reigning educational orthodoxy as abhorrent were it not so largely incomprehensible.

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WORKING FOR A DRUG-FREE FUTURE Suppose, for a moment, that the reproductive success of our DNA had been best served by coding for ecstatically happy vehicles rather than malaise-haunted emotional slum-dwellers. If this had been the case, then none of the pharmacological interventions discussed in The Good Drug Guide would be necessary. Life-long well-being would seem only "natural". We would all enjoy gloriously fulfilled lives. Each day would be animated by gradients of bliss. Unpleasant states of mind would be viewed as a tragic aberration. Bad thoughts and bad feelings could be diagnosed as a freakish but clinically treatable type of psychopathology. Of course, it didn't work out that way. Instead, the inclusive fitness of our genes has been served by the "natural" manufacture of some of the most vicious psychological adaptations imaginable. Sadness and anxiety are "normal". Discontent is "adaptive". Everyday emotional pain is part of "what makes us human". The rot goes deeper. Selfish DNA can count on innumerable dupes to act as its distal representatives even today as the biotech revolution unfolds. The need for "character-building" emotional pain gets justified with all manner of sophistries, both religious and profane. Suffering is good for you, one may be told. It's all part of life's rich tapestry. Actually, suffering exists only because it was good for our genes. Conditionally-activated negative emotions were fitness-enhancing in the ancestral environment. In the current era, apologists for mental pain are serving as the innocent mouthpieces of the nasty bits of code which spawned them. If pressed, primordial DNA's unwitting spokesmen would presumably disavow any such connection. Yet if one were purposely building an intelligent robotic survival-machine, then endowing it with the illusion of free-will would prove a highly fitness-enhancing adaptation. It's a trick which our genes stumbled upon; and then blindly exploited. Fortunately, over the next few centuries humanity will be able to outwit its ancient genetic masters. Our present status as throwaway genetic vehicles will finally be subverted. When gradients of heavenly well-being become the genetically predestined norm of mental health, then the very notion of tampering with our new-won "natural" condition and feeling "drugged" may come to seem immoral. It may also seem perverse. Why should anyone want to contaminate the divine ecstasy of their spirituo-biological soul-stuff with chemical pollutants? No thanks. Today's twisted victims of the primordial genetic code, on the other hand, view the notion of sullying their natural state of being through psychoactive drugs with a much more deep-seated ambivalence. They

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adopt it as a near-universal practice. Given the inadequacy of the thirdrate pharmacological stopgaps on offer, and the lack of any serious drugeducation, it's scarcely surprising we're so poor at using them. Thus concerned parents are surely right to worry about the trashy street drugs taken by their kids. Early in the 21st Century, "Just Say No" is frequently still a good rule-of-thumb. Yet with the right new genes and designerdrugs, there's no reason why mature Post-Darwinian life shouldn't just get better and better. David Pearce

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http://www.thehindu.com/sport/article2158 616.ece Good that drug cheats are being caught: Powell
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The Hindu Former Olympian Mike Powell at the press conference to announce a strategic alliance between Nirmal Lifestyle and the IAAF in Mumbai on Monday. Photo: Vivek Bendre Former world champion long jumper Mike Powell feels that it is a blessing in disguise that athletes who are using banned drugs are being caught by the regulatory authorities. If you look at it, its a good thing. It shows we are taking this seriously. Athletics is one of the few sports which is willing to burst its stars. As of now, if you try to use something you are taking a big, big risk, Powell, currently the brand ambassador of the world athletics body IAAF told reporters here.

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Six track and field athletes, including two Commonwealth and Asian Games gold medallists Mandeep Kaur and Sini Jose, flunked dope tests for anabolic steroids in just two days. Athletics is at the forefront of any sport in the world as far as taking control to eliminate performance enhancing drugs. Its a necessary evil. We have to do it. I know for sure the culture is a lot different now, the 47yearold Philadelphian said. The IAAF signed a 10year deal with realty firm Nirmal Lifestyle to promote the sports in India. However Powell, who broke compatriot Bob Beamons 23yearold record set at the 1968 Mexico Olympics advocates life bans for offenders. I think if you are using drugs, you should be banned for life, he stated. Powell is happy to know that Anju Bobby George, who was under his tutelege eight years back is making a comeback post motherhood, eyeing a berth in the squad for London 2012. Anju is a very talented athlete. If she is healthy, then she has a chance. She is very competitive. When women have children and come back they have a little more strength and determination too. Its worth a try for her. I helped her win a world championship medal (bronze) in 2003 (at Paris). Good luck to Anju. I am very happy for her, said Powell, whose rivalry with Carl Lewis lit up the long jump pit in the late 1980s and early 1990s. Powell declared that it was the continued excellence of Lewis on the long jump pit that paved the way for him to leapfrog Beamons longstanding record. Keywords: Mike Powell

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http://www.naturalnews.com/021369_prescription_drug_abuse_drugs.html

Teen prescription drug abuse on the rise, study finds

2 12 Share Outrageous 0 (NaturalNews) U.S. teens are abusing illegal drugs such as marijuana less, but abuse of legal prescription drugs is rising, according to a new study by the National Institute on Drug Abuse.

06 by: Jessica Fraser Must OMG 0 read 12

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The "Monitoring the Future" study, conducted by the University of Michigan, found that American teens' use of illegal drugs has fallen more than 23 percent since 2001, and underage use of alcohol and cigarettes has similarly declined. "The broad nature of these declines across multiple drugs and alcohol and cigarettes ... is a kind of youth movement for the good," said John Walters, director of the National Drug Control Policy. "This shows us that we can as a society push back and make a difference. When we do that effectively together it has enormous beneficial consequences not only for our children now, but for the rest of their lives." However, an increase in abuse of prescription and over-the-counter medications has left anti-drug campaigners confused as to how to combat the problem of legal drugs. Nearly one in 10 high school seniors reported using the prescription painkiller Vicodin without a prescription, while roughly one in 20 said they had used Oxycontin without a prescription. A recent study by the Partnership for a Drug-Free America found that one out of every five teenagers 12 to 17 years old had purposely abused a prescription drug, while one in 10 said they'd intentionally abused over-the-counter medications, such as cough syrup. "The traditional prevention messages become somewhat confused because there are clearly some circumstances under which these medications are wonderful," said Dr. David Rosenbloom, director of Join Together, a Boston-based nonprofit research organization. "So it's got to be a much more nuanced message and as a practical matter, prevention curricula are still focused on alcohol and illicit drugs." According to Walters, parents play a critical role in combating teenagers' legal prescription drug abuse. "Go to your medicine cabinet, take unused prescription [medications] and throw them away," he said.

Learn more: http://www.naturalnews.com/021369_prescription_drug_abuse_drugs.html#ixzz1UjQL8vwF

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http://www.naturalnews.com/010944_war_on_drugs_the_DEA.html

rugs are bad. Drugs destroy peoples' lives. Didn't you know that marijuana turns regular everyday people into zombie pot smokers? That's why we have a war on drugs in America: to protect our children from potheads. Drugs are bad. Especially marijuana. I learned this the other day when I visited an elementary school as a guest speaker. The schoolchildren were well trained in describing the dangers of drugs. On command, they would spout out any number of statements describing them. But then a funny thing happened. I started asking how many of them were on drugs. You know, drugs their doctor prescribed. Drugs that alter brain chemistry to keep them docile, or free of pain, or to dilate their lungs so they could breathe easier. It turned out that 60% of these schoolchildren were either on drugs at that very moment, or had been on such drugs within the last twelve months. Two-thirds of the teachers were on drugs, too. And it's not at all a stretch to believe that 40% or more of all parents are on drugs. Mild-altering drugs like antidepressants, no less.

A nation of drug addicts

Fact is, we are a nation of drug addicts. We drug ourselves, our elderly and our children on a daily basis. We do it with prescription medications, over-the-counter pills, alcohol, caffeine, nicotine... and we say it's all fine because those drugs are legal. But wait a minute, you say. Those legal drugs are different from marijuana. They're FDAapproved drugs, prescribed by a doctor. They have a medical purpose. Oh really? Ritalin has a medical purpose? What medical symptoms does Ritalin treat, then? What measurable physiological state is addressed with Ritalin? There are none, of course. Ritalin is an authority drug. It keeps children in line. It makes teachers feel less stress and parents feel less guilt. Ritalin is a mind-altering narcotic, and yet millions of children are on it today. Its purpose is not to help children, but to make life more convenient for those who manage children. You think statin drugs have a medical purpose? Think again. In reality, they only have a profit purpose. These drugs were invented to sell pills that manage disease states in people, not that solve any real health problem. Don't believe me? Just stop taking your statin drugs, if you dare, and watch your cholesterol skyrocket. You'll find out you're a slave to the drug, and no healthier than before.

What's the difference between legal and illegal drugs?

So what's the real difference between legal drugs and illegal drugs? Some people think that only illegal drugs are habit-forming. Yet legal drugs can be just as addictive as illegal drugs. Just ask anyone who has tried to quit smoking, go off caffeine, or kick to Oxycontin habit.

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So is there some other difference between illegal drugs and legal drugs? People argue that legal drugs are safe. They're FDA-approved! And yet they fail to recognize that prescription drugs kill more Americans each year than all the crack, meth, and heroin deaths combined. Okay, then, what about the argument that illegal drugs have no medicinal purpose, and legal drugs do have a medicinal purpose. What about that? Wrong again. Medical marijuana is a medically proven treatment for a variety of conditions, yet marijuana still remains illegal. Even MDMA (now called "Ecstasy" on the street) was long considered an effective "experiential drug" that helped severely traumatized adult patients overcome past pains through improved clarity. At the same time, tobacco smoke has no medical purpose whatsoever, yet cigarettes remain perfectly legal. No, the real difference between these two classes of drugs is not their medical merit, nor their safety. The real difference is something far more sinister. It gets right down to answering the question of why DEA agents will raid medical marijuana clinics, yet stand by doing nothing while Americans smoke themselves to death on tobacco. Want to know the real answer? I very much doubt you do. Because, like most Americans, you won't believe it. You've been blinded to the obvious truth for your whole life, manipulated by the media, and brainwashed by advertising that has turned you into a statistically-validated consumer. You'll think, no, this couldn't possibly be true. The world isn't that unjust, you think. But you're wrong. (Take the free Gullibility Factor test to find out if you're really a mind slave or not...) Here's the raw, blunt truth about the war on drugs. Drugs are declared legal or illegal based primarily on who benefits from their manufacture, distribution and sale.

Corporate and government profits determine the legality

Let me put this another way. You know why cigarettes are still legal? Consider this: here's a product that admittedly kills people. It has no health benefit whatsoever. It is a threat to the public health. Yet why does it remain legal? Because states get a cut of cigarette sales thanks to the Big Tobacco settlement a few years back. Keeping cigarettes legal results in desperately-needed revenues for states... revenues that are almost never spent on antismoking campaigns, by the way. It's a classic racket: tobacco is allowed to remain legal because powerful institutions get a cut of the action. While people die from lung cancer, states get financial resuscitation by taking a cut of every sale. States are trading your health for their revenues. Think I'm being overly cynical? Let's take a look at gambling laws. Organized gambling is illegal at both the state and federal levels in this country. Except, of course, when government gets a cut. Casino-friendly states didn't just make casinos legal for the good of the public: they legalized gambling in exchange for a cut of the action. It's a classic, mob-style "protection fee."

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If you want to test this theory, launch your own online gambling website. You'll be shut down almost immediately and charged with serious crimes. Gambling and organized betting is illegal, didn't you know? That is, unless the state runs the show, as in state lotteries. It's right in your face, folks: gambling is legal when powerful corporations or institutions get a piece of the action. It's illegal when they don't. It has nothing at all to do with morality, or protecting people, or doing what's right. It's all about money, pure and simple. Just ask all the corrupt politicians in Missouri who legalized riverboat gambling a few years back. Getting back to drugs, why do you think alcohol remains a legal drug? Because states and cities tax it. State governments are addicted to alcoholics as a source of revenue to fund their voter entitlement programs that get politicians reelected. Alcohol is a cash machine for cities and states. Sometimes the exact same chemical is both legal and illegal, depending on who profits from it. The FDA, for example, banned the Chinese herb ma huang because it contains ephedra. Yet the exact same chemical compound remains perfectly legal in over-the-counter drugs like Sudafed and a variety of cold medicines. Sudafed even gets its name from ephedra: "pseudoephedrine." So why is ephedrine illegal in herbs, yet legal in pharmacy drugs manufactured by drug companies? You already know the answer. With all that in mind, why do you think prescription drugs that kill people remain legal? Think carefully now... If you guessed, "Because powerful corporations generate billions in profits selling drugs, and governments get a cut of that via state sales taxes and corporate income taxes" then BINGO! You win a prize: a lifetime of free Prozac to keep you happy!

Legal drugs generate windfall profits for those in power

Think about it: if prescription drugs were peddled by street dealers instead of doctors, and if all that revenue changed hands in a non-taxable, non-corporate structure (i.e. street cash), then you'd be seeing full-scale law enforcement action against the makers, distributors and sellers of those drugs. You'd also see endless headlines about how dangerous they were: "Street painkillers kill twelve in South Miami!" The sad truth of the matter, though, is that those very same painkilling drugs killed at least twelve people in South Miami this very day. But you'll never here about it in the media. Because the news networks are sponsored by drug companies, of course. (The news is not designed to inform you, it's designed to shape your reality, to turn you into a consumer of whatever products the corporations are peddling this year. Didn't you know?) Every drug that's legal is legal for one simple reason: somebody in a position of power is keeping it legal because they're getting a cut.

Non-patentable drugs are usually outlawed

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That's why medical marijuana is illegal: because government doesn't control its distribution, nor does government receive a financial cut. You can bet your life that if Big Pharma owned the patents on medical marijuana and could set monopolistic prices on it, pot would be perfectly legal to own and smoke. That is, as long as you got it from a pharmacy where prices and distribution could be controlled. Control is the key here. You think the FDA is discrediting drugs from Canada in order to protect your health? Get real. The FDA is simply protecting the monopoly drug market in this country. It's controlling distribution points in the U.S. in the same way that a crack dealer assassinates his street corner competition. Eliminate the competition, and you can set whatever price you want. That's why uninformed U.S. consumers pay 30,000% markup prices for drugs that can be acquired in Mexico or Canada for pennies on the dollar.

It's not about your health, it's about their wealth

You see, corporate America doesn't really care what you put in your mouth, up your nose, through your lungs or into your veins, as long as they get a cut from it. That's the whole prescription drug racket in a nutshell: it's billions of dollars in annual profits generated from mind-altering (yet legal) drugs that flat-out kill people. Lots of people. Like 100,000 Americans a year (or a lot more if you believe more critical statistics). So if you've ever wondered why Ritalin -- which has no medical purpose whatsoever -- is perfectly legal, and yet medical marijuana -- which has a well-proven medical purpose -- is outlawed, now you know the answer: because Ritalin makes powerful people rich. And marijuana doesn't. Anybody can grow marijuana. Drug companies don't control the patents.

Why I teach people to be 100% drug free

Now, just for the record, I do not personally use any drugs whatsoever (recreational, overthe-counter, prescription or otherwise), and in fact, I teach people to be 100% free of all drugs, including caffeine and alcohol. I bought into the "just say no to drugs" advice of Nancy Reagan, and I actually applied it to ALL drugs, not just selective drugs. And as far as I can tell, aside from the Mormons and the Amish, there are only a small percentage of truly drug-free people living in this country. Practically everybody I meet is addicted to at least one of the following: coffee, cigarettes, alcohol, pain meds, prescription drugs or sugar (which alters brain chemistry in drug-like fashion). At the same time, I'm not at all fooled by this silly "War on Drugs" charade, which is really nothing more than enforcement of corporate drug profits at gunpoint. If we had a genuine war on drugs in this country that really worked to protect the American people we'd send DEA agents into drug company offices and confiscate all the legalized but deadly medications being manufactured, distributed and deceptively sold to unwitting Americans today. Medical marijuana is a threat to both the profits and power of drug companies, not to mention the credibility of the DEA. Letting grannies smoke pot in California makes DEA agents look

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silly. If it were allowed, it would also undermine the billions of dollars already spent incarcerating people for "pot crimes." Basically, it would make the whole War on Drugs look stupid. Which it most assuredly is, at least when it comes to marijuana. I can understand taking a tough stance on hard drugs (crack, meth, heroin, etc.), but arresting cancer patients who smoke joints for pain control sounds a lot more like oppression than law enforcement to me. So what is the War on Drugs? It's an excuse to control you. It is a system that keeps the population in a state of constant fear so that heroic politicians can get elected on empty promises to "keep fighting the war on drugs!"

The DEA is AWOL on most drug issues

Where is this War on Drugs when it comes to Grandma in the nursing home, who died of a stroke caused by Cox-2 inhibitor drugs? Where is the War on Drugs when little Johnny schoolboy picks up a rifle and blows away his classmates because he's on antidepressants and can't tell the difference between real life and a first-person-shooter video game? Where is the War on Drugs when 16,500 people each year die, shitting digested blood until they pass out and die because that daily dose of aspirin tore a gaping hole in their stomach? The War on Drugs, you see, turns a blind eye to the death and suffering caused by these drugs. The DEA pretends prescription drugs don't even exist. No prescription drug death has ever been prevented by the DEA as far as I know. Yet 100,000 Americans are killed each year by FDA-approved drugs. The DEA has no interest whatsoever in protecting Americans from these drugs. Ever wonder why? The DEA is properly named, by the way. It's the Drug Enforcement Agency. It's enforcing drugs. The right drugs. The legal drugs. The drugs that make money for drug companies, drug distributors, drug retailers, cities, states and countries. It's enforcement at gunpoint, and as long as the money keeps flowing, the drugs will stay perfectly legal, regardless of who dies. The entire distribution system is well in place: the false and misleading television advertising, the outright bribery of drug dealers (doctors), the street corner fulfillment centers (pharmacies), and the coordinating drug lord running the show (the Fraud and Drug Administration). It's a brilliant system for manufacturing, promoting, delivering and selling deadly, addictive drugs to children, adults and seniors while generating corporate profits and tax revenues for cities, states and nations. And that's the raw truth about the War on Drugs. You may not like it, but now, at least, you know why it exists. So I have a common sense question for all the people in this country. If you support the War on Drugs, then why are you taking so many drugs yourself? And why are you allowing your children to be drugged

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Learn more: http://www.naturalnews.com/010944_war_on_drugs_the_DEA.html#ixzz1UjRU6SD7

http://discovermagazine.com/2009/dec/11-can-an-injection-break-addiction

Can an Injection Break a Cocaine Addiction?

The drug "vaccination" takes away the high, so users have little reason to use. by Boonsri Dickinson From the December 2009 issue; published online February 5, 2010

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iStockphoto Cocaine has such a powerful addictive effect on the brain that its users often struggle through a disheartening loop of rehabilitation and relapse. A treatment developed by Baylor College of Medicine psychiatrist Tom Kosten could soon help users break that cycle. Kosten recently completed the first placebo-controlled clinical trial for a cocaine addiction vaccine. The vaccine, which temporarily blocks the effects of the drug, consists of a cocaine molecule attached to the surface of an inactive cholera toxin protein. After receiving the injection, the body generates antibodies that respond to the cholera protein and the cocaine. If cocaine subsequently enters the bloodstream, the antibodies bind to it and neutralize it before it can reach the brain to cause the release of the neurotransmitter dopamine, the process that makes users feel high.

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In his trial, Kosten found that 50 percent of cocaine users had cocaine-free urine when tested 8 to 16 weeks after vaccination, compared with 35 percent of those who received a placebo shot. When antibodies were blocking cocaine, people who took it didnt get an effect from it, Kosten says, so the drug lost its appeal. One problem revealed by the trial was that only 38 percent of vaccinated subjects developed high levels of antibodies against the drug; Kosten is working to increase the vaccines antibody generation. Additionally, the vaccines protection seems to last for only about two months. Kosten expects that users would receive booster shots every few months for approximately two years to make a complete recovery from the addiction. To check whether vaccinated users were turning to other drugs instead, Kosten tested subjects for methamphetamine (the preferred cocaine alternative) but found no evidence of its use. In addition to the cocaine treatment, Kosten is developing vaccines against heroin, nicotine, and methamphetamine. He has shown in animal tests that treatments targeting those drugs can also produce high levels of antibodies against the addictive compounds.

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http://www.teen-drug-abuse.org/adolescentsubstance-abuse.htm dolescent Substance Abuse

Being a teenager and raising a teenager are individually, and collectively, enormous challenges. For many teens, illicit substance use and abuse become part of the landscape of their teenage years. Although most adolescents who use drugs do not progress to become drug abusers, or drug addicts in adulthood, drug use in adolescence is a very risky proposition. Even small degrees of substance abuse (for example, alcohol, marijuana, and inhalants) can have negative consequences. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug use and abuse. One of the most telling signs of a teen's increasing involvement with drugs is when drug use becomes part of the teen's daily life. Preoccupation with drugs can crowd out previously important activities, and the manner in which the teen views him or her self may change in unrealistic and inaccurate directions. Friendship groups may change, sometimes dramatically, and relationships with family members can become more distant or conflictual. Further bad signs include more frequent use or use of greater amounts of a certain drug, or use of more dangerous drugs, such as cocaine, amphetamines, or heroin. Persistent patterns of drug use in adolescence are a sign that problems in that teen's environment exist and need to be addressed immediately.

What causes adolescent substance abuse?

There is no single cause of adolescent drug problems. Drug abuse develops over time; it does not start as full-blown abuse or addiction. There are different pathways or routes to the development of a teen's drug problems. Some of the factors that may place teens at risk for developing drug problems include:

insufficient parental supervision and monitoring lack of communication and interaction between parents and kids poorly defined and poorly communicated rules and expectations against drug use inconsistent and excessively severe discipline family conflict favorable parental attitudes toward adolescent alcohol and drug use, and parental alcoholism or drug use

It is important to also pay attention to individual risk factors. These include:

high sensation seeking

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impulsiveness psychological distress difficulty maintaining emotional stability perceptions of extensive use by peers perceived low harmfulness to use

How do you know when to seek help?

The earlier one seeks help for their teen's behavioral or drug problems, the better. How is a parent to know if their teen is experimenting with or moving more deeply into the drug culture? Above all, a parent must be a good and careful observer, particularly of the little details that make up a teen's life. Overall signs of dramatic change in appearance, friends, or physical health may be signs of trouble. If a parent believes his or her child may be drinking or using drugs, here are some things to watch for:

Physical evidence of drugs and drug paraphernalia Behavior problems and poor grades in school Emotional distancing, isolation, depression, or fatigue Change in friendships or extreme influence by peers Hostility, irritability, or change in level of cooperation around the house Lying or increased evasiveness about after school or weekend whereabouts Decrease in interest in personal appearance Physical changes such as bloodshot eyes, runny nose, frequent sore throats, rapid weight loss Changes in mood, eating, or sleeping patterns Dizziness and memory problems

Howard Liddle, Ed.D.

http://drugs.about.com/od/howtouseyourmedications/a/drud_disposal.htm

Proper Disposal of Prescription Drugs

Safely Disposing of Your Medications
From Michael Bihari, MD, former About.com Guide Updated August 11, 2008 About.com Health's Disease and Condition content is reviewed by the Medical Review Board
See More About:

expired medications

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storing medications drugs and the environment

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Hospital IncineratorsDesign, Manufacture & Installation Medical & Clinical Waste - ISO 9001www.todaysure.com Thailand Rehab $6,995 USDAsia's Best Drug & Alcohol Rehab. Effective, Affordable, World Class.alcoholrehab.com Many people toss expired or unused medications in the trash or flush them down the toilet. Some components of these drugs end up in our lakes, streams, and water supplies. According to the U.S. Fish and Wildlife Service, The improper disposal of unused medications by flushing them or pouring them down the drain may be harmful to fish, wildlife and their habitats. Additionally, throwing medications away in the garbage may be dangerous since they can end up in the mouths of children or household pets. According to an Associated Press investigation reported in early 2008, A vast array of pharmaceuticals - including antibiotics, anti-convulsants, mood stabilizers and sex hormones - have been found in the drinking water supplies of at least 41 million Americans. Since the amount of the drugs found in our water supply is hundreds or thousands of times lower than the quantity found in the medications that we take, it is not clear what the potential harm is to humans. However, research has shown that there can be effects on animals that live in the water such as fish and frogs.

How Do Medications Get into Our Water?

Drugs enter our water supply in several ways:

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Many of us have medications that we no longer take, that have expired, or were used by someone who died. Most of these medications are flushed down the toilet or, in the case of liquids, poured down sink drains. When we take a medication, our bodies absorb some of the drug. The remainder passes through us (in our urine or stool) and is flushed down the toilet.

In both cases, the wastewater is treated by our local sewage facilities before it is discharged into local reservoirs, rivers or lakes. Most of these water treatments do not remove the entire drug residue. Some of this water then may go to drinking water treatment plants and piped to our faucets.

Federal Guidelines
The U.S. Food and Drug Administration (FDA) and the White House Office of National Drug Control Policy issued the following guidelines in 2007 for the proper disposal of prescription medications:

Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so. If no instructions are given, throw the drugs in the household trash, but first: Remove the drugs from their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who intentionally may go through your trash. Put the drugs (or the mixture of drugs with an undesirable substance) in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag. Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government's household trash and recycling service (see the blue pages in a phone book) to determine if a take-back program is available in your community.

As part of the aforementioned policy, the government recommends the following drugs be flushed down the toilet instead of thrown in the trash. The goal is to reduce the danger of unintentional use or overdose and illegal abuse.
Actiq (fentanyl citrate) Avinza Capsules (morphine sulfate) Baraclude Tablets (entecavir) Daytrana Transdermal Patch (methylphenidate) Duragesic Transdermal System (fentanyl) Fentora (fentanyl buccal tablet) Meperidine HCl Tablets OxyContin Tablets (oxycodone)

MJ Percocet (Oxycodone and Acetaminophen) Reyataz Capsules (atazanavir sulfate) Tequin Tablets (gatifloxacin) Xyrem (Sodium Oxybate) Zerit for Oral Solution (stavudine)

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Disagreement with Federal Drug Flushing Policy

Some states and environmentalists do not agree with the federal governments policy on flushing certain medications. The Florida Department of Environmental Protection states that, Although this method of disposal prevents immediate accidental ingestion, it can cause contamination in our aquatic environment because wastewater treatment systems, including septic tanks, are not designed to remove many of these medications. Instead, this Florida agency outlines a step-by-step method for the safe disposal of all prescription and over-the-counter medications: For Pills and Liquids:
1. Keep the medicines in the original container. This will help identify the contents if they are accidentally ingested. 2. Remove your name and prescription number to safeguard your identity. 3. For pills, add some water or soda to start dissolving them. 4. For liquids, add something inedible like cat litter, dirt or cayenne pepper. 5. Close the lid and secure with duct tape or packing tape. 6. Place the bottle(s) inside an opaque (non see-through) container like a coffee can or plastic laundry bottle. 7. Tape that container closed. 8. Hide the container in the trash. Do not put in the recycle bin. DO NOT give drugs to anyone else. DO NOT flush drugs down the toilet. DO NOT put drugs in the trash without disguising them; human or animal scavengers may find them and misuse them.

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http://health.usnews.com/health-news/diet-fitness/digestivedisorders/articles/2011/08/10/experimental-drug-may-help-ease-chronic-constipation

Copyright 2011 U.S.News & World Report LP All rights reserved.

Posted: August 10, 2011

Us news health

Experimental Drug May Help Ease Chronic Constipation

About one in five taking linaclotide experienced significant relief, manufacturer-funded research shows
Posted: August 10, 2011
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By Serena Gordon HealthDay Reporter

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WEDNESDAY, Aug. 10 (HealthDay News) -- An experimental drug called linaclotide can help reduce the symptoms of chronic constipation, according to new research funded by the drug maker.

In two randomized 12-week trials, about 21 percent of participants taking the drug had at least three spontaneous bowel movements a week, compared to no more than 6 percent of those taking placebo, the study results showed. "People who received the drug had improvement in symptoms, and the treatment was generally well-tolerated," said the study's lead author, Dr. Anthony J. Lembo, an associate professor of medicine at Harvard Medical School and director of the GI Motility Center at Beth Israel Deaconess Medical Center in Boston. The study, which was funded by Ironwood Pharmaceuticals, was published in the Aug. 11 issue of the New England Journal of Medicine. Between 12 percent and 19 percent of Americans have experienced chronic constipation, according to background information in the article. People with chronic constipation generally have fewer than three bowel movements a week, and the bowel movements they have may be hard, lumpy and difficult to pass. To be classified as chronic, these difficulties generally have to occur for at least three months, although Lembo said that most of the people enrolled in the trials had experienced chronic constipation for years. A total of 1,276 people with chronic constipation were enrolled. The study volunteers came from 204 clinical centers in the United States and eight in Canada. Each trial had approximately 600 people who were randomly placed into one of three groups: placebo, 145 micrograms of linaclotide daily, or 290 micrograms of linaclotide daily. Both trials lasted 12 weeks, but the second one had an additional four-week randomized drug withdrawal period as well. The goal of the study was three or more spontaneous bowel movements a week. For the 145 microgram dose, the researchers found that 21.2 percent in the first trial and 16 percent of people in the second achieved the goal. For the 290 microgram dose, the results were 19.4 percent and 21.3 percent respectively. Only 3.3 percent and 6 percent of those on the placebo met the study's goal. In addition to achieving the study goal, the drug helped reduce abdominal discomfort, bloating, and the severity of constipation, according to the researchers. Between 57 percent and 65 percent of the study's participants said they were "quite or very likely" to continue the treatment at the end of the study. The most significant side effect experienced was diarrhea, according to Lembo. About 14 percent to 16 percent of people had diarrhea, but Lembo said that only around 4 percent dropped out due to that side effect.

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But Lembo said that he wasn't sure that everyone was helped by linaclotide. "Chronic constipation is a pretty heterogeneous disorder with different causes. Some cases are related to pelvic floor issues, where the rectal area doesn't relax properly, and I wouldn't expect this medication to be very effective for that type of disorder," he said. Linaclotide's main mechanism of action is to stimulate intestinal secretions, which wouldn't have an effect on rectal muscles. Lembo said the researchers tried to exclude people with constipation related to pelvic floor issues, but that these issues haven't always been diagnosed. "People who suffer from chronic constipation or irritable bowel syndrome with constipation do need more medication choices," said Dr. Roshini Rajapaksa, a gastroenterologist at New York University Langone Medical Center in New York City. "Even though linaclotide was an improvement, only one in five people would have a result. This is probably something we would offer if other options had failed," she added. Rajapaksa recommended that anyone with constipation should make some lifestyle changes - adding more exercise, water and fiber in their diet. But, she said, don't add fiber to your diet too quickly, because too much fiber too soon can cause gas and bloating, and may even worsen constipation. If lifestyle changes don't help, she advised talking to your doctor about other treatment options.

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http://www.drug-addiction-support.org/effects-of-addiction.html Copyright 2011 by Mission Enabled all rights reserved

hat are the major effects of addiction? It is everybodys problem. An addict might say: Im not hurting anybody. Im only hurting myself. For over 30 years the United States government has had its War on Drugs, but in that time frame we have seen in increase in crime, increase in healthcare costs and an alarming increase in the use of dangerous drugs such as cocaine, heroin, crack and methamphetamine. However, we can quickly see that the statement is false, because there is no such thing as an addict who is only hurting him/herself. The problem is found everywhere, from the rich and privileged, to the lost members of society. The War on Drugs has also brought on new research, a greater number of treatment facilities, new and sometimes controversial theories on treatment, advances in drug addiction medications, but are we winning? The effects of drug addiction are far reaching and can be seen in the home, on the job, in churches and in schools.

Illegal Drug are BIG BUSINESS read more...

This section contains some topic areas. To get to more detailed information, just click the headline and that will link you to the next page.

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What are the effects of addiction on health? If left unchecked, the drug is going to win. Drug abuse is a disease of the brain, and the drugs change brain chemistry, which results in a change in behavior. Aside from the obvious behavioral consequences of addiction, the negative effects on a persons health are potentially devastating. While addicts use drugs to feel better, the unintended consequences include but are not limited to overdose, HIV/AIDS, stroke, cardiovascular disease and a host of related maladies. To understand this better you may want to read "Get Sick to Feel Better" a story of the negative effects of addiction... Darci's story of the effects of addiction on her life! Bob was overcome by addiction click here to read his story.

Depression is also an effect of addiction; To learn more about Effects of Addiction -Depression click here. Suicide is also a common effect of drug addiction, to to learn more about drug addiction suicide click here

Click specific information about Cocaine Effects What are the effects of addiction on the family? One of the saddest aspects of the insidious nature of drug addiction is that by the time an addict realizes he/she has a problem, that problem has already taken a heavy toll on the family. Parents in treatment centers tell counselors and therapists that they want to get their kids back, as drug addiction has taken over to the point where the courts have been forced to remove the children from the home. Husbands and wives, brothers and sisters, and sadly children are all impacted. Families can be sources of strength and support, or they can passively enable the addiction to advance. Families can share in the victory over drug addiction, or they can be the victims of it.

Drug Addiction Behavior what is it like, read Candice's story for a description... What are the effects of addiction on our society? The National Library of Medicine estimates that some 20% of all people in the United States have used prescription medication for non-medical purposes. Were not talking about

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cocaine, heroin or methamphetamine use, but doctor-prescribed medication. You can easily see that if you group the two together, illegal drug use and prescription drug misuse, we have a huge problem. What are the effects of addiction on the Law? The news media reports daily struggles with theft, drive-by shootings, drug busts, illegal trafficking and manufacturing of drugs, and arrests for crimes ranging from child neglect to murder. Look closer and chances are great that you will uncover a drug addiction component to any of these stories.

What are the effects of addiction on the economy? Beyond the personal health issues, beyond the devastating effect on families, beyond community crime statistics, drug addiction has a major impact on the American economy. The National Institute on Drug Abuse reported that some $67 billion per year is the impact that drug addiction has on this country. This total includes the cost of law enforcement, incarceration, treatments, traffic injuries, lost time in the workplace, etc. Drug addiction causes impaired reasoning, and therefore the crime rate is dramatically impacted by drug use. Addicts have a much higher likelihood of committing crimes than others. Put some of the factors together-the alcohol-related deaths on our streets and highways, the abuse of the healthcare system by addicts showing up at Emergency Rooms looking for drugs, the absenteeism on the job and the serious risk of HIV infection for those using needles, and you can quickly realize this problem is enormous.

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http://www.drug-addiction-support.org/drug-addiction-symptoms.html

Top 20 questions to assess drug addiction symptoms 1. Has their appearance changed; they don't care how they look? 2. Are they eating properly? 3. Have they lost weight, or have they gained weight? 4. Have you seen needle marks on their arms or legs? 5. Are they slowing down? 6. Do they have the shakes? 7. Are their hands cold and sweaty? 8. Have you smelled something on their breath, or their clothing? 9. Do their eyes appear red? 10. Are their pupils dilated? 11. Is their face puffy? 12. Has their coloring changed, become flushed or pale? 13. Do they have a blank stare? 14. Has their physical coordination changed? Are they staggering?

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15. Have they missed a lot of school, or work? 16. Have their sleep habits changed? Are they always tired? 17. Have they become lazy? 18. Are they hyper? 19. Do they talk a million miles an hour? Do they slur their words? 20. Have you seen drug paraphernalia?

http://www.writefix.com/argument/drugsprobsoln.htm

Drug Abuse: Problems and Solutions

Drug abuse is rife in many countries. Billions of dollars are spent internationally preventing drug use, treating addicts, and fighting drug-related crime. Although drugs threaten many societies, their effects can also be combated successfully. This essay looks at some of the effects of drug use on society, and suggests some solutions to the problem. Drug abuse causes multiple problems for countries and communities. The medical and psychological effects are very obvious. Addicts cannot function as normal members of society. They neglect or abuse their families, and eventually require expensive treatment or hospitalization. The second effect is on crime. Huge police resources are needed to fight smuggling and dealing. Criminal gangs and mafia underworlds develop with the money from drugs. However, the menace of drugs can be fought. Education is the first battle. Children need to be told at home and in school about drugs. People need to be aware of the effects so that they can make avoid this problem. A second approach is to increase police manpower and powers to stop dealers and to enforce the law. However the main target should be the user. Families and counselors need to talk to children and people at risk. Parents need to look at their children and help them to Jobs are needed to give people a role in society. In conclusion, although the problem of drugs may seem impossible to eliminate, there are concrete steps that can be taken to weaken the hold of drugs on society. The danger from drugs is too great to ignore.

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http://www.drug-addiction-support.org/drug-abuse-causes.html Enabled all rights reserved

Copyright

2011

by

Mission

Drug Abuse Causes

About Drug abuse: Drug abuse causes and is caused by many problems including: - Unhappiness

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- Crime - Divorce - Major illness - Even death What are the underlying causes of drug abuse? When we take drugs, either for medical purposes or recreation, there is a benefit or reward that we are trying to achieve. For example pain medication is intended to bring relief to an injured or stressed area of our body. The beginning stages of drug abuse causes us to crave more and to use more. The unintended consequences of that is our need to take more and more of the drug to get the same result. There are many factors that can cause drug addiction, but with the right drug addiction treatment, anybody can be reformed to lead a healthy, productive life. Drug abuse causes the pathways inside the brain to be altered. Physical changes in the nerve cells are brought on by the drug. These cells (neurons) communicate with each other releasing neurotransmitters into the gaps or synapses between the nerve cells. This makes some drugs are more addictive than others. There are several other factors that contribute to drug abuse. Well go into greater detail on another page, but for now the major factors are ones genetic makeup, personality and peer pressure. Again well explain these as we go along. What Are The Risk Factors? Genetic/Inherited We are all a product of our parents. If your parents have addiction struggles, chances are you are more susceptible to addiction. Thats why drug abuse is more common in some families than in others. If your parents smoke, chances are good you will smoke. If your parents used alcohol, youll probably follow and use that drug in much the same way. If your father was an alcoholic, you have a predisposition to abusing that drug. Drug abuse causes one generation to pass it on to the next. Personality Aside from the inherited factors, some people have a personality that is more likely to become drug dependent. - People are curious, so that alone can lead a person to try a drug. We experiment and see what happens.

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- We are looking to relax and have pleasure. - We all want to feel good, and were by nature impatient. Drugs give us an instant gratification that other things do not, so for that moment or hour of for whatever timeframe, we feel good. - We want what we want. - Someone diagnosed with depression, attention deficit disorder, or hyperactivity. - Maybe there has been some stress, or anxiety in their life. Whatever the case, these are contributing factors. Even some common personality characteristics, such as aggression, may be a factor. Children who do not have confidence, healthy self-esteem may be prone to turning to drugs to fill the void. Drug abuse causes negative changes in personality that can lead to an even more destructive behavior. Peer Pressure/Social We are all wired to have relationships, and sometimes those relationships cause us to give in to something we otherwise would avoid in order to maintain the relationship. Peer pressure is huge and nowhere is this greater than during our teenaged years. Kids want to be cool. It begins as a social action, to take the drugs to be a part of the group, to be accepted. Its not just teenagers, as peer pressure takes so many different forms. There is social etiquette, for example, to take a drink during a party. Im a social drinker. How many times have you heard that? Some people actually believe that drug abuse causes you to be accepted and part of the 'popular' group. Easy Access If you want to get drugs, you wont have to look far because they are everywhere. High school students can tell you this. Drug abuse causes people to sell drugs to the most vulnerable population, children. Its not just the stereotypical poor sections of the inner city that serve as the hotbed for drugs. Drugs are found in suburban shopping malls, rural schools, well-to-do private school, on the job in factories, offices and remote job sites. Race, Ethnicity We include this heading because we want to stress that there is no data to support any claim that one race of people or any particular cultural group is more prone to drug abuse than another. Drug abuse is a human problem and crosses all boundaries. Drug abuse causes do not include race. Loneliness, Depression We want to feel good physically and emotionally. Sometimes drugs are the substitution for a healthy life experience. The person in pain and they want to numb the pain. The drug numbs

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the pain and for a moment they dont feel as poorly. The person needs to escape the pain of the life experience, and for a short while, the drug takes them away and they feel better. Anxiety Sometimes people need some help coping with life. Everyday life becomes a struggle and simple things become too much to handle. Drugs are used to deal with it. In the case of addiction, we are not talking about the use of medication, under the care and observation of a doctor. People who have been clinically diagnosed with anxiety can lead a very good life. Were talking here about people who just need to escape. Their drug of choice facilitates that escape.